_{©Kateryna Kon/AdobeStock}

In a new cross-sectional study spanning 5 respiratory syncytial virus (RSV) seasons, nearly one-quarter of hospitalized adults aged 50 years and older with RSV experienced an acute cardiac event.¹

Findings published online April 15, 2024, in JAMA Internal Medicine showed that among nearly 6200 hospitalized older adults with RSV infection, approximately 22% experienced an acute cardiac event, most often acute heart failure (16%). Results also showed that hospitalized patients with RSV who experienced an acute cardiac event had almost twice the risk of severe outcomes compared with those who did not experience an acute cardiac event.¹

“Although acute cardiac events identified in this study cannot be definitively attributed to RSV infection, these findings suggest that acute cardiac events occur frequently among hospitalized older adults with RSV infection and are associated with greater illness severity,” wrote first author Rebecca C. Woodruff, PhD, MPH, of the National Center for Chronic Disease Prevention and Health Promotion at the US Centers for Disease Control and Prevention (CDC), and colleagues.¹

Previous research has shown that respiratory viral diseases, including influenza and COVID-19, are associated with acute cardiovascular disease and mortality. Emerging evidence has raised concerns about acute cardiac complications of RSV infection as well, particularly in older adults, according to the study.¹

“Comprehensive data about potential cardiac complications of RSV infection, similar to what are available for hospitalizations for influenza or SARS-CoV-2 infections could help guide clinical and public health practices, characterize the burden of RSV-associated cardiovascular disease prior to the introduction of novel vaccines, and prompt studies evaluating the prevention of acute cardiac events through RSV vaccination,” noted Woodruff and colleagues.¹

To further examine the prevalence and severity of acute cardiac events during hospitalizations among older adults with RSV infection, researchers examined surveillance data from the RSV Hospitalization Network. The RSV Hospitalization Network is 1 of 3 CDC-supported Respiratory Virus Hospitalization Surveillance Network platforms that conducts detailed population-based surveillance for hospitalizations related to RSV, COVID-19, and influenza.¹

Investigators examined cases of RSV infection in adults aged 50 years and older within 12 states over 5 RSV seasons prior to availability of the vaccines against the infection (annually from 2014-2015 through 2017-2018 and 2022-2023) to estimate the prevalence of acute cardiac events.¹

Participants were defined as having an acute cardiac event if they had either an ICD-9-CM or ICD-10-CM primary or secondary discharge code indicative of an acute cardiac event or heart failure, myocardial infarction, or myocarditis listed as new diagnoses or exacerbations of preexisting diagnoses after discharge. Patients were defined as having a severe outcome if they experienced an intensive care unit (ICU) admission, received invasive mechanical ventilation, or died during hospitalization, noted researchers.¹

FINDINGS

A total of 6248 hospitalized adults (mean age, 72.7 years) with laboratory-confirmed RSV infection were included in the study. Among the cohort, 59.6% were women and 56.4% had underlying cardiovascular disease.¹

Results showed that the weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI 14.6%-17.0%) for acute heart failure, 7.5% (95% CI 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI 0.4%-0.8%) for cardiogenic shock.¹

Researchers observed that relative to patients with no documented history of cardiovascular disease, participants with underlying cardiovascular disease had a greater weighted estimated prevalence of experiencing an acute cardiac event of any category (33.0% vs 8.5%; adjusted risk ratio [aRR ]3.51, 95% CI 2.85-4.32).¹

Among all hospitalized older adults with RSV infection, investigators noted 18.6% required ICU admission, 6.8% required invasive mechanical ventilation, and 4.9% died during hospitalization. Compared with participants without an acute cardiac event, those with an acute cardiac event faced a greater risk of ICU admission (25.8% vs 16.5%; aRR 1.54, 95% CI 1.23-1.93) and in-hospital death (8.1% vs 4.0%; aRR 1.77, 95% CI 1.36-2.31).¹

The results are particularly relevant in light of the US Food and Drug Administration approval of the first 2 RSV vaccines in 2023 for adults aged 60 years and older, recommended for use via shared decision-making with their health care provider, stated researchers. Additional candidate RSV vaccines are in clinical trials, and indications may be expanded to adults aged 50 to 59 years.¹

“This study demonstrates the prevaccine epidemiology of acute cardiac events among adults with RSV-associated hospitalization, which represents a substantial burden of potentially vaccine-preventable disease,” wrote Woodruff et al.¹

In an accompanying editorial, Tracy Wang, MD, of the Patient-Centered Outcomes Research Institute in Washington, DC, and an associate editor at JAMA Internal Medicine noted that uptake of the new RSV vaccines has been low, particularly compared with influenza vaccines.²

"Prior RSV-related efforts have focused on infants and young children, with many clinicians and patients still unaware of RSV burden of disease and prognosis in older adults," wrote Wang, adding that older adults are particularly vulnerable due to more preexisting cardiopulmonary comorbidities and lower functional reserve.²

In the RSV infection surge last year, the CDC reported up to 10 000 deaths in adults aged 60 years and older, with highest risk of severe RSV infections among those living in long-term care facilities or with preexisting lung, heart, or kidney disease or immunosuppression.²

“This report confirms for RSV a similar severity of cardiovascular adverse outcomes observed with other acute respiratory pathogens, such as influenza and SARS-CoV-2, that stem from infection-related metabolic and myocardial stress at the very least, but may also implicate other, more direct pathogen-mediated effects,” stated Wang.²

References:

1. Woodruff RC, Melgar M, Pham H, et al. Acute cardiac events in hospitalized older adults with respiratory syncytial virus infection. JAMA Intern Med. Published online April 15, 2024. doi:10.1001/jamainternmed.2024.0212
2. Wang TY. RSV vaccination-The juice is worth the squeeze. JAMA Intern Med. Published online April 15, 2024. doi:10.1001/jamainternmed.2024.0219