Determinants of Influenza Vaccine Uptake in Patients With Cardiovascular Disease and Strategies for Improvement

Abstract

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Influenza infection is associated with an increased risk of cardiovascular events (myocardial infarction, stroke, and heart failure exacerbation) and mortality, and all‐cause mortality in patients with CVD. Infection with influenza leads to a systemic inflammatory and thrombogenic response in the host body, which further causes destabilization of atherosclerotic plaques. Influenza vaccination has been shown to be protective against cardiovascular and cerebrovascular events in several observational and prospective studies of at‐risk populations. Hence, many international guidelines recommend influenza vaccination for adults of all ages, especially for individuals with high‐risk conditions such as CVD. Despite these long‐standing recommendations, influenza vaccine uptake among US adults with CVD remains suboptimal. Specifically, vaccination uptake is strikingly low among patients aged <65 years, non‐Hispanic Black individuals, those without health insurance, and those with diminished access to healthcare services. Behavioral factors such as perceived vaccine efficacy, vaccine safety, and attitudes towards vaccination play an important role in vaccine acceptance at the individual and community levels. With the ongoing COVID‐19 pandemic, there is a potential threat of a concurrent epidemic with influenza. This would be devastating for vulnerable populations such as adults with CVD, further stressing the need for ensuring adequate influenza vaccination coverage. In this review, we describe a variety of strategies to improve the uptake of influenza vaccination in patients with CVD through improved understanding of key sociodemographic determinants and behaviors that are associated with vaccination, or the lack thereof. We further discuss the potential use of relevant strategies for COVID‐19 vaccine uptake among those with CVD.

The intersectional importance of race/ethnicity, disability, and age in flu vaccine uptake for U.S. adults

“…In other words, PWD were better protected through their or their caretakers’ actions. The tendency for PWD to get vaccinated in this study is consistent with other studies that found individuals with pre-existing medical conditions were more likely to get a vaccine ( Bhugra et al, 2021 ). Individuals who have more contact with the healthcare system or who perceive themselves to be at a higher risk of severe illness from influenza infection may therefore be more likely to receive the vaccination.…”

Medics as a Positive Deviant in Influenza Vaccination: The Role of Vaccine Beliefs, Self-Efficacy and Contextual Variables

“…The positive connections existed also in non-medics but were weaker. This indicates that all these vaccine cognitions should be enhanced because they capture the most relevant factors in the 4C (confidence, convenience, complacency, calculation) model of vaccine hesitancy [ 52 ].…”

COVID-19-Induced Cardiovascular Damage Differs from other Prevalent Viruses

“…The pathologies associated with how influenza viral infection leads to cardiovascular dysfunction are summarized in [ Table 3 ]. [ 66 ],[ 67 ],[ 68 ] The CDC reports people with heart disease or those with a past medical history of a stroke are at higher risk for developing serious flu complications. [ 1 ] Kwong et al .…”

“…[ 73 ],[ 74 ] This inflammatory reaction occurs in the coronary bed and atherosclerotic plaques leading to endothelial dysfunction, vasoconstriction, platelet activation, and dysregulation of the coagulation system. [ 68 ] Along with those effects, the brain increases sympathetic activity and metabolic demand. Changes in circulatory volume and vascular tone cause plaque destabilization, increasing the risk for acute myocardial infarction.…”