Matthew T Mefford1, Ran Liu2, Katia Bruxvoort2, Lei Qian2, Jonathan M Doris3, Sandra Y Koyama4, Hung Fu Tseng2, Kristi Reynolds2. 1. Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. matthew.t.mefford@kp.org. 2. Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. 3. Department of Cardiac Electrophysiology, Kaiser Permanente Southern California, Los Angeles, CA, USA. 4. Internal Medicine, Kaiser Permanente Southern California, Baldwin Park, CA, USA.
Abstract
BACKGROUND: Influenza infection can result in decompensation or exacerbation of heart failure (HF) symptoms, hospitalization, and death. OBJECTIVE: To examine the association of influenza vaccination with mortality and hospitalization during influenza and non-influenza seasons between 2009 and 2018. DESIGN, SETTING, AND PARTICIPANTS: In this prospective, observational cohort study, we included Kaiser Permanente Southern California members with a HF diagnosis prior to September 1 each year from 2009 to 2017. EXPOSURE: The first influenza vaccination in each season (September 1 to May 31) was recorded. Vaccinated/unvaccinated patients were matched 1:1 on age, sex, and ejection fraction at the vaccination date (n-total = 74,870). MAIN OUTCOMES: Patients were followed through the end of each influenza season for all-cause mortality. Secondary outcomes included cardiovascular mortality and all-cause hospitalization. In a sensitivity analysis, we examined mortality in the non-influenza season. RESULTS: Influenza vaccinated vs unvaccinated patients had more comorbidities and higher healthcare utilization. After multivariable adjustment for utilization, sociodemographics, comorbidities, and medications, influenza vaccinated vs unvaccinated patients had a lower risk of all-cause mortality and cardiovascular mortality during the influenza season (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.63, 0.70 and HR 0.68, 95% CI 0.63, 0.74, respectively) but a higher risk of all-cause hospitalization (HR 1.27, 95% CI 1.21, 1.31). There was no association between influenza vaccination and all-cause or cardiovascular mortality during the non-influenza season (HR 0.99, 95% CI 0.89, 1.09 and HR 1.00, 95% CI 0.84, 1.21, respectively). CONCLUSIONS: Influenza vaccination in HF patients was associated with a lower risk of mortality during the influenza season. Our findings provide support for recommendations of universal influenza vaccination in patients with HF.
BACKGROUND: Influenza infection can result in decompensation or exacerbation of heart failure (HF) symptoms, hospitalization, and death. OBJECTIVE: To examine the association of influenza vaccination with mortality and hospitalization during influenza and non-influenza seasons between 2009 and 2018. DESIGN, SETTING, AND PARTICIPANTS: In this prospective, observational cohort study, we included Kaiser Permanente Southern California members with a HF diagnosis prior to September 1 each year from 2009 to 2017. EXPOSURE: The first influenza vaccination in each season (September 1 to May 31) was recorded. Vaccinated/unvaccinated patients were matched 1:1 on age, sex, and ejection fraction at the vaccination date (n-total = 74,870). MAIN OUTCOMES: Patients were followed through the end of each influenza season for all-cause mortality. Secondary outcomes included cardiovascular mortality and all-cause hospitalization. In a sensitivity analysis, we examined mortality in the non-influenza season. RESULTS: Influenza vaccinated vs unvaccinated patients had more comorbidities and higher healthcare utilization. After multivariable adjustment for utilization, sociodemographics, comorbidities, and medications, influenza vaccinated vs unvaccinated patients had a lower risk of all-cause mortality and cardiovascular mortality during the influenza season (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.63, 0.70 and HR 0.68, 95% CI 0.63, 0.74, respectively) but a higher risk of all-cause hospitalization (HR 1.27, 95% CI 1.21, 1.31). There was no association between influenza vaccination and all-cause or cardiovascular mortality during the non-influenza season (HR 0.99, 95% CI 0.89, 1.09 and HR 1.00, 95% CI 0.84, 1.21, respectively). CONCLUSIONS: Influenza vaccination in HF patients was associated with a lower risk of mortality during the influenza season. Our findings provide support for recommendations of universal influenza vaccination in patients with HF.
Authors: Clyde W Yancy; Mariell Jessup; Biykem Bozkurt; Javed Butler; Donald E Casey; Monica M Colvin; Mark H Drazner; Gerasimos S Filippatos; Gregg C Fonarow; Michael M Givertz; Steven M Hollenberg; JoAnn Lindenfeld; Frederick A Masoudi; Patrick E McBride; Pamela N Peterson; Lynne Warner Stevenson; Cheryl Westlake Journal: Circulation Date: 2017-04-28 Impact factor: 29.690
Authors: Vendula Blaya-Nováková; Francisco J Prado-Galbarro; Antonio Sarría-Santamera Journal: Eur J Public Health Date: 2016-09-10 Impact factor: 3.367
Authors: H Kaya; O Beton; G Acar; A Temizhan; Y Cavusoğlu; U Guray; M Zoghi; D Ural; A Ekmekci; H Gungor; I Sari; D Oguz; H Yucel; A Zorlu; M B Yilmaz Journal: Herz Date: 2016-07-26 Impact factor: 1.443
Authors: Jane S Saczynski; Alan S Go; David J Magid; David H Smith; David D McManus; Larry Allen; Jessica Ogarek; Robert J Goldberg; Jerry H Gurwitz Journal: J Am Geriatr Soc Date: 2013-01 Impact factor: 5.562
Authors: Sanjay Poudel; Fadi Shehadeh; Ioannis M Zacharioudakis; Giannoula S Tansarli; Fainareti N Zervou; Markos Kalligeros; Robertus van Aalst; Ayman Chit; Eleftherios Mylonakis Journal: Open Forum Infect Dis Date: 2019-04-02 Impact factor: 3.835
Authors: Paul A Heidenreich; Xin Zhao; Adrian F Hernandez; Clyde W Yancy; Lee H Schwamm; Nancy M Albert; Gregg C Fonarow Journal: J Am Heart Assoc Date: 2014-09-10 Impact factor: 5.501