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Acute Cardiovascular Events Associated With Influenza in Hospitalized Adults
TAKE-HOME MESSAGE
- A study of patients hospitalized for influenza from 2010 through 2018 found that 11.7% had acute cardiovascular events during their hospitalizations. Risk was increased for older patients and those with underlying cardiovascular disease, diabetes, renal disease, or tobacco use.
- This study becomes increasingly important as we enter flu season and want to provide our patients with current information regarding the risk of influenza infection. This study specifically highlights patient populations that are at higher risk for developing complications as inpatients.
– Andrea Dotson, MD, MSPH
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Influenza may contribute to the burden of acute cardiovascular events during annual influenza epidemics.
OBJECTIVE
To examine acute cardiovascular events and determine risk factors for acute heart failure (aHF) and acute ischemic heart disease (aIHD) in adults with a hospitalization associated with laboratory-confirmed influenza.
DESIGN
Cross-sectional study.
SETTING
U.S. Influenza Hospitalization Surveillance Network during the 2010-to-2011 through 2017-to-2018 influenza seasons.
PARTICIPANTS
Adults hospitalized with laboratory-confirmed influenza and identified through influenza testing ordered by a practitioner.
MEASUREMENTS
Acute cardiovascular events were ascertained using discharge codes from the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification, and ICD, 10th Revision. Age, sex, race/ethnicity, tobacco use, chronic conditions, influenza vaccination, influenza antiviral medication, and influenza type or subtype were included as exposures in logistic regression models, and marginal adjusted risk ratios and 95% CIs were estimated to describe factors associated with aHF or aIHD.
RESULTS
Among 89 999 adults with laboratory-confirmed influenza, 80 261 had complete medical record abstractions and available ICD codes (median age, 69 years [interquartile range, 54 to 81 years]) and 11.7% had an acute cardiovascular event. The most common such events (non-mutually exclusive) were aHF (6.2%) and aIHD (5.7%). Older age, tobacco use, underlying cardiovascular disease, diabetes, and renal disease were significantly associated with higher risk for aHF and aIHD in adults hospitalized with laboratory-confirmed influenza.
LIMITATION
Underdetection of cases was likely because influenza testing was based on practitioner orders. Acute cardiovascular events were identified by ICD discharge codes and may be subject to misclassification bias.
CONCLUSION
In this population-based study of adults hospitalized with influenza, almost 12% of patients had an acute cardiovascular event. Clinicians should ensure high rates of influenza vaccination, especially in those with underlying chronic conditions, to protect against acute cardiovascular events associated with influenza.
Additional Info
Disclosure statements are available on the authors' profiles:
Acute Cardiovascular Events Associated With Influenza in Hospitalized Adults: A Cross-Sectional Study
Ann. Intern. Med 2020 Aug 25;[EPub Ahead of Print], EJ Chow, MA Rolfes, A O'Halloran, EJ Anderson, NM Bennett, L Billing, S Chai, E Dufort, R Herlihy, S Kim, R Lynfield, C McMullen, ML Monroe, W Schaffner, M Spencer, HK Talbot, A Thomas, K Yousey-Hindes, C Reed, S GargFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Influenza and Acute Cardiovascular Events
Despite the ongoing morbidity and mortality of the COVID-19 pandemic, which seems to consume much of our current medical attention, we need to expand our horizons and keep in mind those other pathogens waiting in the wings. Accordingly, emphasis is now being directed to our annual influenza vaccination campaigns out of a concern for the potential convergence of COVID-19 and influenza.[1]
Influenza continues to be a major seasonal pathogen resulting in an estimated 140,000—810,000 hospitalizations and 12,000—61,000 deaths per year in the U.S. A recent study underscores influenza’s association with acute cardiovascular events in hospitalized patients.[2] The authors, using data drawn from patients within the U.S. Influenza Hospitalization Surveillance Network, evaluated nearly 90,000 hospitalized adults with laboratory-confirmed influenza. Data were reviewed over eight influenza seasons and acute cardiovascular events were ascertained from discharge diagnoses.
Overall, nearly 12% of influenza hospitalizations were associated with an acute cardiovascular event, including 6.2% with acute heart failure (aHF) and 5.7% with acute ischemic heart disease (aIHD). Influenza plus an acute cardiovascular event resulted in longer lengths of stay (5 vs. 3 days), increased need for ICU (31.2% vs. 13.5%) and ventilator support (14.0% vs. 5.3%), and increased mortality (7.3% vs. 2.5%). Older age, current tobacco use, chronic heart failure or cardiomyopathy, coronary heart disease, diabetes mellitus, and chronic renal failure were all associated with both aHF and aIH in adjusted, multivariate analyses.
Key points for clinicians include the following:
References