Hi. I am Dr. Joe Bresee from the Centers for Disease Control and Prevention's Influenza Division. I am pleased to speak with you today as part of the CDC Expert Commentary Series on Medscape.
Influenza can be a serious illness in your patients with heart disease. Your strong recommendation for an annual flu shot is critical to make sure that your patients get vaccinated and reduce their chances of becoming severely ill from influenza.
Cardiac disease has long been recognized as a risk factor for complications from the flu, including hospitalization and death.
According to a 3-year study conducted from 2005 through 2008, more than one third of adults hospitalized with laboratory-confirmed influenza had cardiac disease. During the 2010-2011 influenza season, among adults hospitalized with lab-confirmed flu, approximately 38% had underlying cardiac disease -- and cardiac disease was the most often reported high-risk condition. Data from the 2009 H1N1 pandemic also support the contribution of cardiac disease to influenza hospitalizations.
A study in Canada was conducted in patients with lab-confirmed flu. In this study, having underlying cardiac disease was associated with a 2.7 times increased risk for flu-related hospitalization.
Studies also have been conducted on the impact of influenza vaccination in patients with cardiac disease. No randomized clinical trials have been conducted in the United States or Canada because of ethical concerns, given the long-standing recommendations to vaccinate patients with cardiac disease in these countries. However, 2 randomized studies have been conducted in other countries, both of which demonstrated a reduction in cardiovascular events in vaccinated patients.
A study in Argentina was conducted in patients with recent ischemic events or who were undergoing angioplasty. The study found significant reductions in cardiovascular deaths at 1 year, from 6% in vaccinated patients to 17% in unvaccinated patients.
In a study in Thailand, patients were included if they were recently hospitalized with acute coronary syndrome. This study found a reduction in a combined endpoint of major cardiovascular events, including death, from 19% in those who were unvaccinated to 9.5% in those who were vaccinated against influenza.
For decades, the CDC's Advisory Committee on Immunization Practices has recommended annual flu vaccine for persons with cardiac disease and other high-risk conditions.
In addition, the American Heart Association and the American College of Cardiology recommend flu vaccination for secondary prevention of cardiac-related events in persons with coronary and other atherosclerotic vascular disease.
For patients with cardiac disease and other chronic medical conditions, the inactivated influenza vaccine -- or flu shot -- should be used. The nasal spray vaccine, which is a live vaccine, should not be used.
Despite the known increased risk for severe influenza in cardiac patients and recommendations for vaccination, many patients are still not getting vaccinated.
Only about 40% of adults 19-64 years old with cardiac disease reported influenza vaccination during the 2007-2008 through the 2009-2010 influenza seasons. Vaccination rates in other high-risk groups, including persons with asthma and diabetes, also were unacceptably low.
A strong recommendation from you is the key to getting your patients vaccinated against the flu. Studies show that a strong provider recommendation for flu vaccination significantly increases a patient's willingness to accept vaccination.
Ideally, all providers, including specialists and primary care providers, should both recommend and offer flu vaccines to their patients. If you cannot provide flu shots in your office or clinic, make a concrete referral for your patients to other providers or locations that can.
In summary, your cardiac patients are at increased risk for severe illness from the flu and should receive influenza vaccine each year. You can make a difference by ensuring that your patients receive a flu shot this and every flu season. Thank you.
Web Resource
CDC Seasonal Influenza: Information for Health Professionals
Joseph Bresee, MD, is Chief of the Epidemiology and Prevention Branch in CDC's Influenza Division, and is a captain in the U.S. Public Health Service. His branch is responsible for conducting influenza surveillance, working to understand influenza disease burden, helping to derive appropriate vaccine and antiviral use policies to prevent seasonal influenza, detecting and preventing avian influenza and pandemic influenza, and providing technical expertise to global public health partners.
Dr. Bresee trained at Baylor College of Medicine in Houston and then completed his pediatric residency at Children's Hospital and Medical Center at the University of Washington in Seattle. Dr. Bresee joined CDC in 1993 as an Epidemic Intelligence Service (EIS) officer in the Influenza Branch. From 1995 to 2005, Dr. Bresee served as a staff epidemiologist and medical officer, specializing in viral gastrointestinal infections and respiratory infections. Subsequently, he was promoted to Epidemiology Team Lead. His research and public health activities focused on rotavirus disease and rotavirus vaccines, and he worked to ensure that rotavirus vaccines were available for children in the United States as well as those living in developing countries.
Dr. Bresee continues to work as a general pediatrician on staff at Grady Healthcare. He attends a weekly clinic for an underserved population in Atlanta. Dr. Bresee has authored more than 150 peer-reviewed papers and textbook chapters.
