COVID-19 vaccines: powerful medicine in HF, but adoption is lagging

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Vaccination against SARS-CoV-2 offers substantial benefits for those affected heart failure but many of these high-risk patients are hesitant to get vaccinated, new research shows.

Unvaccinated patients were three times more likely to die of COVID-related illness than those who were fully vaccinated (relative risk [HR], 0.36; 95% CI, 0.30 – 0.43) or enhanced by vaccine (RR, 0.33; 95% CI, 0.23 – 0.48).

There was no significant difference in mortality between partially vaccinated and unvaccinated patients (RR, 0.87; 95% CI, 0.68, 1.12).

Unvaccinated or partially vaccinated patients were also significantly more likely to be admitted to hospital (incidence rate ratio [IRR]0.68) and require ICU admission (IRR, 0.63), even after adjusting for relevant factors such as age, gender, race/ethnicity, obesitydiabetes and lung disease.

“Despite conservative statistical approaches, the risk reports were striking,” said lead author Anuradha Lala, MD, Icahn School of Medicine at Mount Sinai in New York. lecoeur.org | Medscape Cardiology.

Although the study was underpowered to detect differences between patients who were boosted and those who were fully vaccinated, COVID-19 vaccines appeared to benefit those who were boosted by the vaccine the most, follow-ups of fully vaccinated, partially vaccinated and unvaccinated patients.

“These are observational data, so causality cannot be proven, but it certainly underscores the profound protective effects of vaccination against COVID-19 in patients with heart failure,” she said. .

Commenting on the study of lecoeur.org | Medscape Cardiology, Ileana L Piña, MD, MPH, Thomas Jefferson University, Philadelphia, PA, said this was a single-center study of patients in the Epic registry system, but was conducted during an active period of the pandemic in New York.

“I think that should reassure the population with heart failure to get vaccinated, because there’s definitely an impact on how well you do without excess mortality,” she said.

The results, published on June 9 in the heart failure journal, were drawn from 7094 patients with a diagnosis of heart failure (HF) who had visits to Mount Sinai Health System between January 1, 2021 and January 24, 2022. They were on average 73 years old and 48% were female.

Based on the chart review, 31% of patients were fully vaccinated with two doses and 14.8% were subsequently given a booster, per Centers for Disease Control and Prevention guidelines at the time.

Another 9.1% of patients were partially vaccinated with one dose, while 45% were still unvaccinated in January 2022.

Of the 904 patients who died during an average follow-up of 9 months, 73.4% were unvaccinated or only partially vaccinated.

Previous work has shown that patients with IC are at higher risk of complications if infected with COVID and face almost twice the risk of death than those without IC. The corollary of how COVID-19 vaccines are protective in HF, however, has been missing and was a key driver in getting the study started, Lala observed.

Early in the vaccine rollout, professional societies like the Heart Failure Society of America statements issued offering assurance on the safety of vaccines, but the fear remains.

“As a heart failure cardiologist, I see patients at the clinic all the time who are afraid to get vaccinated,” Lala said. “And when I review and ask why, many of them mention that, ‘I already have a history of heart failure and have heard reports of myocarditis and that the vaccine can negatively affect my heart. So I don’t want to take that risk. “

“It was difficult to convince some patients that the cardiovascular benefits of vaccination far outweighed the risk of complications, as concrete evidence specific to the heart failure population was lacking,” she said.

What the retrospective study cannot answer is whether concerns about myocarditis may resonate more in patients with HF or other cardiovascular disease. Patients with chronic diseases are generally more likely to get vaccinated than the general public.

On the other hand, misinformation abounds and studies have reported that the risk of myocarditis is around 0.24% with SARS-CoV-2 infection versus 0.002%, or around 100 times less, with a COVID vaccine. -19, observed Lala.

“My personal view is that myocarditis, following vaccination, has been sensationalized and not contextualized with the relative risk of having myocarditis and other complications from COVID-19,” she said.

Piña said she encountered similar resistance and misconceptions. “They say I don’t want virus in my system, thinking the vaccine has live virus in it, which is another thing we have to clear up – what the vaccine is made of,” she said.

To determine whether adverse events were associated with COVID, investigators performed a secondary analysis of 1,767 patient encounters with at least one positive test for SARS-CoV-2.

The results show that SARS-CoV-2 positivity was associated with higher rates of hospitalization (IRR, 1.67), ICU admission (IRR, 2.01), and mortality (HR, 3.01). 39; P value for all < .001).

Among patients who tested positive, vaccinated status was associated with lower hospitalization rates (HR, 0.83; P = 0.02), admission to intensive care (IRR, 0.57; P = 0.009) and mortality (HR, 0.35; P = 0.045) compared to unvaccinated status.

“COVID-19 is still upon us, so we can’t get complacent,” Lala said. “I think we often blame it on the patient, ‘Oh, they refused the vaccination.’ But I think we need to do a better job of understanding what the barriers are in their minds to getting vaccinated, what the fears are, what the resistance is, and then look to fill those gaps with knowledge and data that’s applicable to them. . »

The authors note that the study did not capture HIV status, hospitalization, or death in other hospital systems; did not distinguish between patients having HF with preserved or reduced ejection fraction (HFpEF/HFrEF) or according to HF stage; and that data on specific treatments for HF or COVID-19 were not available.

“They didn’t distinguish between HFrEF and HFpEF, but if you look at the population, they’re in the mid-70s age bracket, so that’s the population you know when they have heart failure can getting sicker,” Piña remarked. “By age alone, it’s a vulnerable population, which makes that even more valuable.”

“And they had enough women. Most of the heart failure trials only have an average of 20% women and here they had 48% women, which tells me they probably have a lot of HFpEF here too,” she said. “So the message to the public is, please get vaccinated, your risks are much better if you do well.”

The study received internal support. Lala received personal fees from Zoll, outside of submitted work. Piña said she served on the advisory board of ViFor Pharma.

Card J failed. Published online June 9, 2022. Full Text

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