Associations between Combined Influenza and Pneumococcal Pneumonia Vaccination and Cardiovascular Outcomes

Abstract

Background: In 2017, the CDC listed heart disease as the leading cause of death, with pneumonia and influenza being the eighth cause of death. Several studies have suggested the protective effects of influenza vaccination on myocardial infarction (MI). Available evidence supports the use of influenza vaccination in decreasing cardiovascular events, and the Joint Commission considers influenza vaccination a metric of quality care for hospitalized patients. Our specific aim was to evaluate the combined use of pneumococcal pneumonia vaccine (PPV) and influenza vaccine on cardiovascular outcomes and mortality. Methods: A retrospective observational study was conducted using the 2012-2015 US National Inpatient Sample (NIS) database, to compare cardiovascular events in adult patients who did and did not receive vaccination during their hospitalization. ICD-9 codes were used to extract data for specific variables. The outcomes included MI, transient ischemic attacks, cardiac arrest, stroke, heart failure, and death. Adjusted relative risks (RR) were calculated using survey-weighted generalized linear models after adjusting for gender, race, socioeconomic status, diabetes, hypertension, hyperlipidemia, smoking status, prior coronary artery disease, and cerebrovascular disease. The effect of vaccination on in-hospital mortality was assessed in each subgroup of cardiovascular events using RR regressions.

HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings

“…Therefore, the HEARTS Clinical Pathway incorporated an immunization chart as part of the continuum of care. These recommendations increase the integration between communicable and non-communicable diseases, reinforcing the perspective of vaccination as a preventive strategy for CVD and preparation for future pandemics (31)(32)(33). This effort will effectively address the CVD burden, strengthen the resilience of health systems, and defend against the current COVID-19 pandemic and future public health emergencies (34).…”

Influenza vaccination in mitigating vascular events and risk

“…Infection with influenza is associated with acute cardiovascular events, including heart failure exacerbations, acute coronary syndromes, strokes, and overall cardiovascular mortality. Influenza can precipitate acute MI by means of inflammatory cytokine release, atherosclerotic disruption, and provoking prothrombotic events [12 ▪▪ ]. Furthermore, influenza influences cardiovascular events through sympathetic activation, endothelial dysfunction, increasing cardiometabolic demands, and compromising lung function [12 ▪▪ ].…”

“…Influenza can precipitate acute MI by means of inflammatory cytokine release, atherosclerotic disruption, and provoking prothrombotic events [12 ▪▪ ]. Furthermore, influenza influences cardiovascular events through sympathetic activation, endothelial dysfunction, increasing cardiometabolic demands, and compromising lung function [12 ▪▪ ]. Available data suggests that seasonal influenza vaccination is very effective in mitigating this risk by either preventing influenza infection or by preventing severe infection [12 ▪▪ ].…”

“…This very large study included 22 634 643 hospitalizations, with average age of 57.3 years, and 58.9% being women. Vaccination against influenza was associated with lower MI (RR = 0.84, 95% CI 0.82–0.87, P < 0.001), transient ischemic attacks (RR = 0.93, 95% CI 0.9–0.96, P < 0.001), cardiac arrest (RR = 0.36, 95% CI 0.33–0.39, P < 0.001), stroke (RR = 0.94, 95% CI 0.91–0.97, P < 0.001), and overall mortality (RR = 0.38, 95% CI 0.36–0.4, P < 0.001) [12 ▪▪ ]. Table 1 lists the pivotal studies of influenza vaccination and cardiovascular benefits associated with vaccination.…”

“…Ma et al evaluated the impact of influenza vaccine on cardiovascular outcomes and mortality in the US National Inpatient Sample (NIS) database [12 ▪▪ ]. The NIS database serves as a large US national inpatient healthcare database, which assesses utilization, access, charges, quality, and outcomes nationally for various diseases among hospitalized patients.…”