Annual flu shot may protect cardiovascular disease patients

American Heart Association/American College of Cardiology scientific advisory

DALLAS, Sept. 19 – The American Heart Association and the American College of Cardiology are asking heart doctors to do something they may not normally do — give flu shots to their patients. However, patients with cardiovascular disease should not get the nasal-spray flu vaccine.

Patients with cardiovascular disease are more likely to die from influenza than patients with any other chronic condition, according to the new AHA/ACC scientific advisory.

Studies have found that annual flu vaccinations can prevent death in adults and children with chronic conditions of the cardiovascular system. But only one in three adults with cardiovascular disease was vaccinated against flu in 2005.

“If we vaccinated at least 60 percent of the 13.2 million people with coronary heart disease in the United States against influenza, we could prevent hundreds of deaths and thousands of cases of flu each year,” said Matthew M. Davis, M.D., lead author of the advisory and associate professor of pediatrics, internal medicine, and public policy at the University of Michigan in Ann Arbor.

“The target goal set by the U.S. Department of Health and Human Services is to vaccinate 60 percent of people with heart disease under age 65, and 90 percent of everyone 65 and over, many of whom have heart disease,” Davis said.

Overall, influenza is responsible for 36,000 deaths and 225,000 hospitalizations in the United States each year. People with cardiovascular disease are particularly vulnerable, because the flu can exacerbate heart disease symptoms directly, and can also lead to conditions like viral or bacterial pneumonia that cause flare-ups of cardiovascular disease, he said.

“A case of influenza tends to make people with heart disease even sicker than others who are healthy, and increases the chance of having to go to the hospital,” he said.

Immunization against seasonal influenza has a critical, but underappreciated, role in preventing death among cardiovascular disease patients. In May 2006, new American Heart Association/American College of Cardiology joint guidelines on preventing recurrent cardiovascular events recommended an annual flu shot for all people with cardiovascular disease.

“Influenza vaccination is now recommended with the same enthusiasm as cholesterol and blood pressure control and other modifiable risk factors for cardiovascular disease,” the advisory noted.

The strongest evidence of a protective effect comes from the FLUVACS trial. In that trial, 301 people hospitalized for either a heart attack or an angioplasty and stent procedure to open clogged arteries were randomly assigned to receive flu vaccine or remain unvaccinated. Over the next year, among those who did not get vaccinated 23 percent had died of heart disease, had a nonfatal heart attack or developed severe ischemia (insufficient blood supply to the heart tissue), compared with only 11 percent of their vaccinated counterparts.

A visit to the cardiologist presents a good, but often missed, opportunity to get vaccinated, Davis said. “Most people with heart disease visit their cardiologists during the time when they should get the flu shot, but only about half of cardiologists in the United States stock the vaccine in their clinics.”

The advisory authors said immunization isn’t perceived as part of a typical cardiology practice. But the most effective way to increase the number of cardiovascular patients vaccinated is to have flu vaccine available in all cardiology practices and to have physicians strongly recommend the vaccine to their patients. Most insurance plans cover flu vaccinations.

The advisory urges:

* Cardiologists to stock flu vaccine for their patients in their clinics and strongly encourage influenza immunization.

* Patients with cardiovascular disease to get a flu vaccination (given by injection) every year by the end of November. Receiving a shot in January or even later should still protect from flu, as the flu season in the United States typically peaks in January, February or March.

* Patients with cardiovascular disease not receive the live, attenuated vaccine given as a nasal spray. The live vaccine can cause influenza in this high-risk population.

Last year’s shot won’t offer protection this year, because the dominant strains of influenza virus change each year. The vaccine, which takes about two weeks to become effective, “is reformulated each year to respond to these changes as best we can,” Davis said.

The Centers for Disease Control and Prevention also recommends annual influenza vaccination for people age 50 and older; children ages 6 months to 59 months; women who will be pregnant during flu season; and adults and children with other chronic conditions.

The advisory is endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Association of Critical Care Nurses, the American Association of Heart Failure Nurses, the American Diabetes Association, the Association of Black Cardiologists, Inc., the Heart Failure Society of America, and the Preventive Cardiovascular Nurses Association.

The American Academy of Nurse Practitioners supports the recommendations of this scientific advisory. This science advisory is consistent with the recommendations of the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices.

Co-authors are Kathryn Taubert, Ph.D.; Andrea L. Benin, M.D.; David W. Brown, M.S.P.H., M.Sc.; George A. Mensah, M.D.; Larry M. Baddour, M.D.; Sandra Dunbar, R.N., D.S.N., and Harlan M. Krumholz, M.D.

The advisory is available online at www.americanheart.org and www.acc.org; and will be published in Circulation: Journal of the American Heart Association and Journal of the American College of Cardiology.

Editor’s note: For more information on influenza visit www.americanheart.org/flu.

NR06 – 1085 (Circ/Flu advisory/Davis)

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