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Excess Morbidity and Mortality Associated With Flu in HF
Quick Takes
- Increased influenza activity was associated with increased rates of all-cause death, CV death, and hospitalizations with pneumonia or influenza among HF patients in Denmark.
- Furthermore, seasonal influenza activity accounted for 2.6% of all all-cause deaths, 2.9% of CV deaths, and 5% of all hospitalizations with pneumonia or influenza in HF patients.
- These data serve to further reinforce current guidelines and underscore the importance of high vaccination coverage of HF patients.
Study Questions:
What is the excess burden of morbidity and mortality, as determined by annual excess number of deaths and hospitalizations associated with influenza infection in patients with heart failure (HF) in Denmark?
Methods:
The investigators collected nationwide data on weekly number of deaths and hospitalizations among HF patients in Denmark and weekly estimates of influenza circulation, as determined by the proportion of positive influenza samples analyzed at all Danish Hospitals. These data were correlated in a time series linear regression model and this model was used to estimate the annual excess number of deaths and hospitalizations attributable to influenza circulation among HF patients in Denmark. The model also included data on weekly mean temperature and restricted cubic spline terms to account for seasonality and trends over time. The authors fitted linear regression models linking weekly outcome numbers with influenza circulation to estimate the excess mortality and morbidity associated with influenza circulation in HF patients.
Results:
Data were available from 2010 to 2018 encompassing eight influenza seasons with an annual mean of 25,180 samples tested for influenza at Danish hospitals. Among an annual mean of 70,570 HF patients, the model estimated that influenza activity was associated with an annual excess of 250 all-cause deaths (95% confidence interval [CI], 144-489) corresponding to 2.6% of all all-cause deaths (95% CI, 1.5%-5.1%) in HF patients. Similarly, influenza activity was associated with an annual excess of 115 cardiovascular (CV) deaths (95% CI, 62-244) corresponding to 2.9% of all CV deaths (95% CI, 1.5-6.1%). Influenza activity was also associated with an annual excess of 251 hospitalizations for pneumonia or influenza (95% CI, 107-533) corresponding to 5.0% of all hospitalizations for pneumonia or influenza.
Conclusions:
The authors report that influenza activity likely causes substantial morbidity and mortality among HF patients.
Perspective:
This study reports that increased influenza activity was associated with increased rates of all-cause death, CV death, and hospitalizations with pneumonia or influenza among HF patients in Denmark. Furthermore, seasonal influenza activity accounted for 2.6% of all all-cause deaths, 2.9% of CV deaths, and 5% of all hospitalizations with pneumonia or influenza in HF patients. These data serve to further reinforce current guidelines and underscore the importance of high vaccination coverage of HF patients. The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure recommends that in HF patients, vaccinating against respiratory illnesses is reasonable to reduce mortality.
Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Cardiovascular Care Team, Prevention
Keywords: Heart Failure, Influenza, Human, Influenza Vaccines, Pneumonia, ESC Congress, ESC24
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