RSV Vaccination Linked to Lower Mortality in Heart Failure Cohort
Key Takeaways
- Among older adults with heart failure in the United States, documented RSV vaccination was associated with significantly lower all-cause mortality than no documented vaccination.
- ICU admission was significantly less common with documented RSV vaccination.
- Overall healthcare utilization was significantly higher with documented vaccination, while the separate inpatient or emergency-visit comparison was not statistically significant.
- Respiratory failure, heart failure exacerbation, myocardial infarction, and stroke did not differ significantly between the matched groups.
In Khan and colleagues’ Clinical Cardiology RSV vaccination analysis, investigators used the TriNetX US Collaborative Network for a multicenter retrospective electronic-health-record cohort. Eligible adults were aged at least 60 and had a recent HF diagnosis. Vaccination was identified from codes recorded during the reported ascertainment window; the comparison group lacked documented vaccination. Propensity matching on demographics, comorbidities, and medications yielded 777 adults in each group, with measured baseline characteristics balanced. All-cause mortality was the primary outcome; secondary outcomes included respiratory failure, cardiovascular events, overall healthcare utilization, and a separate inpatient or emergency-visit measure. The mortality survival curve began on day 14 after index, and investigators also examined two older-adult age bands.
All-cause mortality was 3.8% with documented vaccination versus 11.1% without documented vaccination. The associated hazard ratio (HR) was 0.51 (95% confidence interval [CI] 0.33–0.79). These were deaths from any cause, not deaths established as RSV-related.
Intensive care unit (ICU) admission occurred in 2.7% of adults with documented vaccination versus 5.8% of those without documented vaccination. The HR was 0.46 (95% CI 0.25–0.86).
Overall healthcare utilization was higher with documented vaccination, with an HR of 1.85 (95% CI 1.65–2.08), whereas the separate inpatient or emergency-visit comparison was not statistically significant. Respiratory failure, HF exacerbation, myocardial infarction, and stroke also showed no significant between-group differences. Higher overall utilization and nonsignificant cardiovascular comparisons appeared in both examined age bands; age-specific mortality and ICU estimates were not reported.
Matching measured characteristics could not eliminate healthy-vaccinee or healthcare-engagement confounding, including differences in HF severity or phenotype, frailty, functional status, and preventive-care behavior. Vaccinations outside participating systems could have been missed, and index-date or immortal-time bias remains possible. The analysis lacked laboratory-confirmed RSV endpoints and reliable cause-specific deaths, and multiple outcomes were examined without multiplicity adjustment. The authors suggested greater overall utilization might reflect outpatient or other non-acute engagement, but did not establish a mechanism or define the components of that measure. Platform analytics were accessed before the stated vaccination-window endpoint; the mortality curve’s extended time axis does not establish uniform observed follow-up. Khan and colleagues characterized the mortality and ICU associations alongside higher utilization as hypothesis-generating, not proof that vaccination caused the survival difference.
Clinician Questions
How was RSV vaccination documented in older adults with heart failure?
For US adults aged at least 60 with heart failure, documented RSV vaccination was identified using Current Procedural Terminology (CPT) codes 90678 or 90679 or legacy International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code V04.82. Someone without a captured code could still have received vaccination outside participating health systems.
Which patients with heart failure were excluded from the older-adult RSV vaccination comparison?
Among adults aged at least 60 with heart failure, those with coded congenital heart disease, blood or blood-forming-organ disease or immune disorders, or other rheumatic heart disease recorded before cohort assignment were excluded. The findings do not directly establish outcomes for those excluded groups.
What analyses could clarify whether RSV vaccination causes lower mortality in older adults with heart failure?
Khan and colleagues identified negative-control outcomes and RSV-season-restricted comparisons as ways to assess bias. They also discussed active-comparator approaches and prospective evaluation in better-characterized HF phenotypes as future research.