But also no evidence this is tied to mortality or rehospitalization
In recent years, one in three patients hospitalized with heart failure were discharged without getting the recommended flu or pneumococcal vaccine, albeit without worse clinical outcomes, analysis of the Get With The Guidelines-Heart Failure (GWTG-HF) registry showed.
Overall, 68% of the 303,761 heart failure patients in the registry from 2012 through 2017 were vaccinated for influenza at the time of discharge, with a nonsignificant drop over this period. Of those who were vaccinated, 84% had received it before hospitalization, reported Adrian Hernandez, MD, MHS, of Duke Clinical Research Institute in Durham, North Carolina, and colleagues in JACC: Heart Failure.
The similar pneumococcal vaccination rate of 66% among heart failure patients at discharge overall actually significantly declined over the study period (71% in 2012-2013 to 60% in 2016-2017, adjusted OR 0.75 per calendar year, 95% CI 0.67-0.84).
Hospitals with higher vaccination rates tended to perform better on heart failure quality of care measures. The proportion of discharged patients who met five GWTG-HF achievement measures was higher when centers vaccinated more for influenza (94% top quartile care versus 86% for lowest quartile, OR 2.72, 95% CI 1.88-3.94) and pneumococcal illness (95% versus 88%, 95% CI 4.52, 95% CI 3.06-6.68).
Yet more vaccinations didn't translate into better clinical outcomes: Among individuals 65 years or older with linked Medicare claims, the investigators observed similar rates of 1-year mortality and rehospitalization whether or not the patients got the influenza or pneumococcal vaccines.
While it's "biologically plausible" to assume that preventing pulmonary infections would prevent some patients from being admitted for heart failure, the five randomized clinical trials that investigated the role of influenza vaccination in preventing cardiovascular events focused primarily in patients with coronary artery disease, such that data regarding the heart failure population is "surprisingly limited," according to Luis Beck da Silva, MD, ScD, and Luis Eduardo Rohde, MD, ScD, both of Brazil's Hospital de Clínicas de Porto Alegre.
"International guidelines are consensual to recommend influenza and pneumococcal immunization in heart failure patients but this may be far from an equipoise clinical practice. Randomized controlled data are definitely needed to thoroughly assess the relationship between vaccination and clinical outcomes in heart failure patients," they wrote in an accompanying editorial.
Among the 392 centers included in the study, smaller and Northeast hospitals were more likely to have heart failure patients discharged with the flu and pneumococcal vaccines. Vaccine recipients were in turn older and more likely to be white, female, and have insurance.
Hernandez and colleagues acknowledged that they potentially underestimated the vaccination rates in the study since they couldn't count those who got the vaccines after hospital discharge. Another limitation was their reliance on a self-selected pool of GWTG-HF-participating hospitals.
The Get With The Guidelines–Heart Failure program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable.
Hernandez declared research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, and Novartis; and honoraria from Bayer, Boston Scientific, and Novartis.
Beck da Silva and Rohde reported no relevant conflicting interests.
JACC: Heart Failure
Source Reference: Bhatt AS, et al "Vaccination trends in patients with heart failure: Insights from Get With The Guidelines-Heart Failure" JACC Heart Fail 2018.
JACC: Heart Failure
Source Reference: Beck da Silva L, Rohde LE "Vaccinations in heart failure: An expert-opinion based recommendation that deserves randomized validation" JACC Heart Fail 2018.
Read the original article on Medpage Today: Many HF Patients Leave the Hospital Without Their Shots