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FLU SHOT OR NOT IN CHRONIC HEART FAILURE
- Mitja Lainscak, Theresa McDonagh, Tiny Jaarsma on behalf of the Committee on Patient Care of the Heart Failure Association of the European Society of Cardiology (14 October 2009)
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Mitja Lainscak, Head, Division of Cardiology University Clinic Golnik, Golnik 36, SI-4204 Golnik, Slovenia, Theresa McDonagh, Tiny Jaarsma on behalf of the Committee on Patient Care of the Heart Failure Association of the European Society of Cardiology
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Respiratory infections are important precipitating factors for deterioration of chronic cardiac disease, which increases morbidity and mortality in chronic heart failure (CHF). Nowadays, we have nearly exhausted clinically available measures which alter the natural history of CHF [1] thus we have to actively seek for novel and preferably preventive strategies [2]. Influenza is a typical potentially preventable seasonal infectious disease where targeted vaccination could be beneficial. Guidelines suggest yearly influenza vaccination and vaccination against pneumococcal disease yet the evidence is far from robust [1]. This may be primary reason for relatively low recall (38%) of vaccination advice as reported by patients being recently hospitalized for heart failure [3]. In view of there being only few studies in the field, de Diego et al [4] provide important observational data which suggests benefits of influenza vaccination in patients >65 years with chronic cardiac disease. Annual influenza vaccine status in 1340 community-dwelling patients ranged from 64% to 72% and they report a 37% winter mortality risk reduction (hazard ratio 0.63, 95% confidence interval 0.44-0.91) conferred by influenza vaccination. The estimated 122 annual vaccinations to prevent one death may seem high but vaccination is a once-yearly event with little complications thus it is highly cost and labour effective [5]. Nonetheless, before vaccination receives a higher priority in our clinical practice, several issues have to be acknowledged. Diagnosis of chronic heart disease was based on electronic records which could cause certain bias. Influenza vaccination primarily prevents deterioration of disease with subsequent reduction of morbidity and mortality; it would therefore be extremely relevant to evaluate morbidity reduction (which equals cost reduction), focusing on clinically relevant influenza and hospitalizations in time dependent manner after vaccination. Evaluating cause of death could better estimate the relative contribution of vaccination to mortality risk reduction. Additionally, it would be interesting to see whether there were differences between patients with CHF and coronary artery disease. To properly address raised issues, a proper, preferably randomized interventional trial is warranted. In the field of CHF, activities have been initiated by the Committee on Patient Care of the Heart Failure Association of the European Society of Cardiology. We plan to activate the established heart failure clinics network to reach sufficient sample size for morbidity (and mortality) effect evaluation. Through this trial, we could further foster close cooperation between key persons providing patient care and potentially provide an important preventive strategy in CHF. REFERENCES 1. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Tendera M, Auricchio A, Bax J, Böhm M, Corrà U, della Bella P, Elliott PM, Follath F, Gheorghiade M, Hasin Y, Hernborg A, Jaarsma T, Komajda M, Kornowski R, Piepoli M, Prendergast B, Tavazzi L, Vachiery JL, Verheugt FW, Zamorano JL, Zannad F. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur J Heart Fail 2008;10:933-989. 2. Jaarsma T, van Veldhuisen DJ. When, how and where should we "coach" patients with heart failure: the COACH results in perspective. Eur J Heart Fail 2008;10:331-333. 3. Lainscak M, Cleland JGF, Lenzen MJ, Nabb S, Keber I, Follath F, Komajda M, Swedberg K. Patient recall of lifestyle advice in patients recently hospitalized with heart failure: a EuroHeart Failure survey analysis. Eur J Heart Fail 2007;9:1095-103. 4. de Diego C, Vila-Corcoles A, Ochoa O, Rodriguez-Blanco T, Salsench E, Hospital I, Bejarno F, del Puy Muniain M, Fortin M, Canals M, and EPIVAC Study Group. Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease. Eur Heart J 2009;30:209-216. 5. Ryan J, Zoellner Y, Gradl B, Palache B, Medema J. Establishing the health and economic impact of influenza vaccination within the European Union 25 countries. Vaccine 2006;24:6812-22. Conflict of Interest:None declared |
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