Vaccination for Respiratory Infections in Patients with Heart Failure

Abstract

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.

Outcomes of COVID-19 in patients vaccinated and unvaccinated against SARS-CoV-2 and suffering from pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

“…Vaccination against COVID-19 in PAH/CTEPH patients is recommended based on expert opinion and observations from the general population [13,16,17]. Experts suggest prioritization of vaccination for patients with heart failure, including PAH and CTEPH, especially those in the NYHA (New York Heart Association) functional class 3 or 4 and who are advanced in age and have comorbidities [13,16,17]. Our results confirm the validity of these recommendations.…”

“…Thirty-two these patients (38%) contracted COVID-19 before the vaccination program, while 53 (62%) got COVID-19 when immunization was available. Vaccination against COVID-19 in PAH/CTEPH patients is recommended based on expert opinion and observations from the general population [13,16,17]. Experts suggest prioritization of vaccination for patients with heart failure, including PAH and CTEPH, especially those in the NYHA (New York Heart Association) functional class 3 or 4 and who are advanced in age and have comorbidities [13,16,17].…”

Development of Core Educational Content for Heart Failure Patients in Transition from Hospital to Home Care: A Delphi Study

“…Therefore, washing hands and wearing a mask are very important [ 54 ]. In particular, these respiratory infections lower lung function, aggravate HF, and put more strain on the heart, so education has been focused on preventing influenza and pneumonia [ 55 ]. Considering the current COVID-19 pandemic, this educational material can be an important part of a self-care guide for HF patients.…”

COVID-19 Vaccination in Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: Safety Profile and Reasons for Opting against Vaccination

“…Experts strongly recommend that patients with chronic heart failure, including PAH/ CTEPH patients should receive COVID-19 vaccination as soon as possible [16,17]. Other authors recommend prioritization of COVID-19 vaccination in patients with cardiovascular disease, according to the stage of the main disease and comorbidities.…”