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Influence of influenza vaccination on recurrent hospitalization in patients with heart failure

Einfluss der Grippeimpfung auf wiederkehrende Hospitalisierungen von Herzinsuffizienzpatienten

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Abstract

Background

The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction.

Methods

The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination.

Results

During a mean follow-up of 15 ±6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model – in addition to a few clinical factors – vaccination status (HR = 0.30, 95 % CI = 0.17–0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17–0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH.

Conclusion

Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

Zusammenfassung

Hintergrund

Die aktuelle Studie zielte darauf ab, den Einfluss regelmäßiger Grippeimpfungen auf den Tod aus kardiovaskulärer Ursache und Hospitalisierungen wegen Herzinsuffizienz (HFrH) bei stabilen ambulanten Patienten mit Herzinsuffizienz („heart failure“, HF) und verminderter Ejektionsfraktion zu untersuchen.

Methoden

Das türkische Wissenschaftlerteam HF (TREAT-HF) stellt ein Netzwerk dar, das multizentrische Beobachtungs-Kohorten-Studien bei HF durchführt. Die vorliegende Studie besteht aus einer Subgruppenanalyse von ambulanten Kohorten des TREAT-HF, die einen Fragebogen zum Grippeimpfstatus ausfüllten und bei denen Nachbeobachtungsdaten verfügbar waren. Insgesamt wurden 656 Patienten mit verfügbaren Follow-up-Daten zum Tod aus kardiovaskulärer Ursache und HFrH einschließlich wiederkehrender Hospitalisierung in die Studie eingeschlossen. Die Patienten wurden auf 2 Gruppen aufgeteilt: jene, die regelmäßig eine Grippeimpfung erhielten (40 %), und jene, die keine Impfung bekamen.

Ergebnisse

Während einer durchschnittlichen Nachbeobachtung von 15 ±6 Monaten kam es bei 113 (18 %) Patienten zum kardiovaskulär bedingten Tod und bei 471 (72 %) Patienten zu mindestens einer HFrH. Die Todesrate aus kardiovaskulärer Ursache war in beiden Patientengruppen ähnlich (16 vs. 19 %; p = 0,37), während HFrH und wiederkehrende HFrH bei Patienten, die eine regelmäßige Grippeimpfung erhielten, signifikant seltener waren als bei jenen, die keine Impfung erhielten (43 vs. 92 % bzw. 16 vs. 66 %; p < 0,001). In einem multivariaten Cox-Proportional-Hazards-Modell – zusätzlich zu einigen wenigen klinischen Faktoren – blieben der Impfstatus (HR = 0,30; 95 %-KI = 0,17–0,51; p < 0,001) und ein Universitätsabschluss (HR = 0,35; 95 %-KI = 0,17–0,72; p = 0,004) unabhängig voneinander mit dem Risiko wiederkehrender HFrH assoziiert.

Schlussfolgerung

Eine regelmäßige Grippeimpfung hat keinen Einfluss auf den Tod aus kardiovaskulärer Ursache, senkt aber die HFrH einschließlich wiederkehrender Episoden von HFrH bei ambulanten Patienten mit Herzinsuffizienz und verminderter Ejektionsfraktion.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Cardiology, Cumhuriyet University, 58140, Sivas, Turkey

    H. Kaya, O. Beton, H. Yucel, A. Zorlu & M. B. Yilmaz

  2. Faculty of Medicine, Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey

    G. Acar

  3. Cardiology Clinics, Yukses Ihtisas Training and Research Hospital, Ankara, Turkey

    A. Temizhan

  4. Faculty of Medicine, Department of Cardiology, Osmangazi University, Eskisehir, Turkey

    Y. Cavusoğlu

  5. Cardiology Clinics, Ankara Numune Training and Research Hospital, Ankara, Turkey

    U. Guray

  6. Faculty of Medicine, Department of Cardiology, Ege University, Izmir, Turkey

    M. Zoghi

  7. Faculty of Medicine, Department of Cardiology, Koc University, Istanbul, Turkey

    D. Ural

  8. Cardiology Clinics, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    A. Ekmekci

  9. Faculty of Medicine, Department of Cardiology, Adnan Menderes University, Aydın, Turkey

    H. Gungor

  10. Faculty of Medicine, Department of Cardiology, Marmara University, Istanbul, Turkey

    I. Sari

  11. Faculty of Medicine, Department of Cardiology, Baskent University, Ankara, Turkey

    D. Oguz

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  1. H. Kaya
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  2. O. Beton
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  15. M. B. Yilmaz
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TREAT-HF Investigators

Corresponding author

Correspondence to H. Kaya.

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Conflict of interest

H. Kaya, O. Beton, G. Acar, A. Temizhan, Y. Cavusoğlu, U. Guray, M. Zoghi, D. Ural, A. Ekmekci, H. Gungor, I. Sari, D. OguzMD., H. Yucel, A. Zorlu, M.B. Yilmaz, and the TREAT-HF investigators state that there are no conflicts of interest.

The accompanying manuscript includes an observational study on humans. Ethical approval number of the study is HNEAH-KAEK 2015/03 HNEAH-KAEK 2015/KK/03.

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Kaya, H., Beton, O., Acar, G. et al. Influence of influenza vaccination on recurrent hospitalization in patients with heart failure. Herz 42, 307–315 (2017). https://doi.org/10.1007/s00059-016-4460-2

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  • DOI: https://doi.org/10.1007/s00059-016-4460-2

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