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Influenza Vaccine in Heart Failure.
Circulation. 2019 01 29; 139(5):575-586.Circ

Abstract

BACKGROUND

Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF.

METHODS

We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134 048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression.

RESULTS

Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7-6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination.

CONCLUSIONS

In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination.

Authors+Show Affiliations

Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark. Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark.Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark. Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark.Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark. Department of Cardiology, Rigshospitalet (L.K.), University of Copenhagen, Denmark.Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.).Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.).Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.).Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark. Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark.Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30586760

Citation

Modin, Daniel, et al. "Influenza Vaccine in Heart Failure." Circulation, vol. 139, no. 5, 2019, pp. 575-586.
Modin D, Jørgensen ME, Gislason G, et al. Influenza Vaccine in Heart Failure. Circulation. 2019;139(5):575-586.
Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza Vaccine in Heart Failure. Circulation, 139(5), 575-586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788
Modin D, et al. Influenza Vaccine in Heart Failure. Circulation. 2019 01 29;139(5):575-586. PubMed PMID: 30586760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influenza Vaccine in Heart Failure. AU - Modin,Daniel, AU - Jørgensen,Mads Emil, AU - Gislason,Gunnar, AU - Jensen,Jan Skov, AU - Køber,Lars, AU - Claggett,Brian, AU - Hegde,Sheila M, AU - Solomon,Scott D, AU - Torp-Pedersen,Christian, AU - Biering-Sørensen,Tor, PY - 2018/12/28/pubmed PY - 2019/11/19/medline PY - 2018/12/28/entrez KW - communicable diseases KW - heart failure KW - influenza, human KW - prognosis KW - survival KW - therapeutics KW - vaccination SP - 575 EP - 586 JF - Circulation JO - Circulation VL - 139 IS - 5 N2 - BACKGROUND: Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF. METHODS: We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134 048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression. RESULTS: Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7-6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination. CONCLUSIONS: In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/30586760/Influenza_Vaccine_in_Heart_Failure_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.118.036788?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -