Bronchopulmonary infections are a major trigger of cardiac decompensation and are frequently associated with hospitalizations in patients with heart failure (HF). Adverse cardiac effects associated with respiratory infections, more specifically Streptococcus pneumoniae and influenza infections, are the consequence of inflammatory processes and thrombotic events. For both influenza and pneumococcal vaccinations, large multicenter randomized clinical trials are needed to evaluate their efficacy in preventing cardiovascular events, especially in HF patients. No study to date has evaluated the protective effect of the COVID-19 vaccine in patients with HF. Different guidelines recommend annual influenza vaccination for patients with established cardiovascular disease and also recommend pneumococcal vaccination in patients with HF. The Heart Failure group of the French Society of Cardiology recently strongly recommended vaccination against COVID-19 in HF patients. Nevertheless, the implementation of vaccination recommendations against respiratory infections in HF patients remains suboptimal. This suggests that a national health policy is needed to improve vaccination coverage, involving not only the general practitioner, but also other health providers, such as cardiologists, nurses, and pharmacists. This review first summarizes the pathophysiology of the interrelationships between inflammation, infection, and HF. Then, we describe the current clinical knowledge concerning the protective effect of vaccines against respiratory diseases (influenza, pneumococcal infection, and COVID-19) in patients with HF and finally we propose how vaccination coverage could be improved in these patients.

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The objective of this study was to assess the impact of the COVID-19 pandemic on patients’ perceptions regarding infection risk and vaccination in subjects suffering from chronic diseases. A prospective observational multicentric study conducted from December 2020 to April 2021 in three French University Hospitals. Patients with chronic diseases were proposed to complete a questionnaire regarding the impact of the COVID-19 pandemic on infectious risk knowledge and vaccination. A total of 1151 patients were included and analyzed (62% of which were people with diabetes). The COVID-19 pandemic increased awareness of infectious risks by 19.3%, significantly more in people with diabetes (23.2%, from 54.4% to 67.0%, p < 0.01) when compared to the other high-risk patients (12.5%, from 50.5% to 56.8%, p = 0.06). Respectively, 30.6% and 16.5% of patients not up-to-date for pneumococcal and flu vaccines reported wanting to update their vaccination due to the COVID-19 pandemic. By contrast, the proportion of patients against vaccines increased during the COVID-19 pandemic (6.0% vs. 9.5%, p < 0.01). The COVID-19 pandemic has led to a small increase in awareness regarding the risks of infection in patients with chronic diseases, including people with diabetes, but without any change in willingness to be vaccinated. This underlines the urgent need to sensibilize people with diabetes to infection risk and the importance of vaccination.

Sleep disturbances are frequent among patients with heart failure (HF). We hypothesized that self-reported sleep disturbances are associated with a poor prognosis in patients with HF. A longitudinal study of 119 patients with HF was carried out to assess the association between sleep disturbances and the occurrence of major cardiovascular events (MACE). All patients with HF completed self-administered questionnaires on sleepiness, fatigue, insomnia, quality of sleep, sleep patterns, anxiety and depressive symptoms, and central nervous system (CNS) drugs intake. Patients were followed for a median of 888 days. Cox models were used to estimate the risk of MACE associated with baseline sleep characteristics. After adjustment for age, the risk of a future MACE increased with CNS drugs intake, sleep quality and insomnia scores as well with increased sleep latency, decreased sleep efficiency and total sleep time. However, after adjustment for left ventricular ejection fraction and hypercholesterolemia the HR failed to be significant except for CNS drugs and total sleep time. CNS drugs intake and decreased total sleep time were independently associated with an increased risk of MACE in patients with HF. Routine assessment of self-reported sleep disturbances should be considered to prevent the natural progression of HF.

Incidence and mortality rates for cardiovascular disease are declining, but it still remains a major cause of morbidity and mortality. Drug treatments to slow the progression of atherosclerosis focus on reducing cholesterol levels. The paradigm shift to consider atherosclerosis an inflammatory disease by itself has led to the development of new treatments. In this article, we discuss the pathophysiology of inflammation and focus attention on therapeutics targeting different inflammatory pathways of atherosclerosis and myocardial infarction. In atherosclerosis, colchicine is included in new recommendations, and eight randomized clinical trials are testing new drugs in different inflammatory pathways. After a myocardial infarction, no drug has shown a significant benefit, but we present four randomized clinical trials with new treatments targeting inflammation.

In patients with heart failure (HF), respiratory infections are responsible for acute exacerbation and increased hospitalization. Vaccination may reduce the incidence and/or severity of respiratory infections, and thereby, reduce the risk of HF exacerbation. Despite current recommendation, vaccination coverage (VC) for patients with HF remains far too limited. To study the VC of HF patients followed in our hospital and to precise the strategies desired by the patients in order to carry out the vaccination. This was a prospective monocentric descriptive study conducted between December 2019 and January 2021. Patients with HF history hospitalized in cardiology unit (CU) and patients in a HF telemonitoring program (TP) were included. An interview was conducted by a pharmacist to find out the patient's vaccination status regarding influenza and pneumococcus, together with socio-demographic clinical data. During the interview for non-vaccinated patients, opinion and willingness to be vaccinated were obtained. Data from 335 patients were collected (185 in CU, 150 in TP). The mean age was 69.3 years, and sex ratio was 2.6. About 65% were vaccinated against influenza in the last year (60% in CU, 72% in TP, p=0.022) and 22% had pneumococcal vaccination in the last 5 years (11% in CU, 35% in TP, p&lt;0.001). Respectively 64% of patients with HF with reduced ejection fraction (HFrEF) and 67% of patients with HF with preserved ejection fraction (HFpEF) were vaccinated against influenza (p=0,63) against 25% of patients with HFrEF and 19% with HFpEF for pneumococcus (p=0,27). 68% of the patients were in favour of the vaccination, 23% had a mixed opinion and 9% were against it. Among patients not vaccinated against influenza or pneumococcus, 17% refused to be vaccinated. Among unvaccinated patients who consider vaccination, 69% wanted to be vaccinated by their general practitioner (GP) and 7% wanted to be vaccinated by their cardiologist. Almost 1/3 of unvaccinated patients who were included in CU wanted a vaccine prescription at discharge. Among the vaccinated patients, information on the need to be vaccinated had been provided to them mostly by health insurance (73%) and their GP (19%) for the influenza vaccine and by their cardiologist (55%) and GP (32%) for the pneumococcal vaccination. The VC of HF patients remains insufficient, particularly against pneumococcus, as described by Kopp and al. Patients in TP are more vaccinated than patients in CU, which could involve better management. Moreover, the low rate of vaccinated patients is mainly explained by a lack of awareness, as most of the unvaccinated would like to be vaccinated. About 2/3 of patients wanted to be vaccinated by their GP, and thus play a major role in their global care. The higher vaccination rate for influenza, which unlike pneumococcus benefits from a national vaccination campaign, demonstrates that improvements are needed in the institutional promotion of vaccination for HF patients. Funding Acknowledgement Type of funding sources: None.

BackgroundPrevious studies have reported that clinical pharmacists improve medication safety. A clinical pharmacy team (1 senior pharmacist, 1 junior pharmacist, 7 student pharmacists) was deployed in cardiology units (79 beds) to develop medication reconciliation (MR), identify medication errors (ME) and optimise patients’ pharmacotherapy.PurposeThe aim of this study was to describe and analyse pharmacists’ interventions in cardiology units over 9 month and to evaluate their impact on the management of cardiovascular diseases.Material and methodsThis work was a prospective, non-randomised, observational study performed between December 2015 and August 2016. Interventions were made during MR or during the prescriptions analysis in cardiology (1 intensive care, and 2 clinical units). Analysis criteria were number and type of ME, proportions of drugs involved in ME and the physicians’ acceptance rate. A focus on cardiovascular ME was made to highlight interventions about management of heart failure (HF) and acute coronary syndrome (ACS).ResultsA total of 532 interventions were performed for 339 patients. Mean (median) age was 70.4 (72) years. The 3 most frequent types of ME were incorrect dose (overdosage (107; 20.1%) and underdosage (96; 18%)), untreated indication (178; 33.5%) and inappropriate form of administration (52; 9.8%). 48.5% of pharmacists’ interventions were identified by MR. The percentage of intervention accepted was 98.2% and concerned mostly treatments of the cardiovascular system (137; 25.8%), alimentary tract and metabolism (94; 17.7%), and nervous system (80; 15%). In the cardiovascular system, the most prevalent drugs therapy involved were statins (35; 25.6%), ACE inhibitors (21; 15.3%) and beta-blockers (18; 13.1%). 39 (28.5%) and 31 (22.6%) of interventions for cardiovascular drugs improved HF and ACS therapies, respectively.ConclusionThese results highlight a positive impact of the pharmacy team on reduction of ME. Prescription analysis and MR are 2 key points in avoiding medication discrepancies. The pharmacist has become a key member in the cardiology team. They are involved in therapeutic strategy, and most of the interventions concerned cardiovascular drugs. Moreover, half of these interventions involved treatment of HF and ACS, so pharmacists can improve the management of these chronic diseases.References and/or acknowledgementsAcknowledgements to cardiology teams.No conflict of interest

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