Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Heart. 2020 Mar;106(5):350-357. doi: 10.1136/heartjnl-2019-315193. Epub 2019 Aug 23.
Despite the progression of treatments over decades, heart failure (HF) is a disease with high morbidity, mortality and economic burden. Influenza infection is an important trigger for cardiovascular (CV) events, including HF. Influenza vaccination has been seen to reduce the risk of CV mortality in patients with coronary disease, but the effect in patients with HF is still unclear. Therefore, we conducted a systematic review to evaluate the effect of influenza vaccination in the morbimortality of patients with HF.
MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Health Technology Assessment and PsycINFO databases (December 2018) were searched for longitudinal studies evaluating influenza vaccination compared with a non-vaccination control group in patients with HF. The risk of bias was assessed according to the ROBINS-I tool. We performed a random-effects meta-analysis to estimate the pooled HRs with 95% CIs, and heterogeneity was evaluated using the I statistics.
Six cohort studies evaluating 179 158 patients with HF were included in the meta-analysis. Influenza vaccination was associated with a lower risk of all-cause mortality (HR=0.83; 95% CI 0.76 to 0.91; I=75%). The effect of the influenza vaccination was not statistically significant in a pooled analysis of CV mortality (HR=0.92, 95% CI 0.73 to 1.15; 2 studies) and of all-cause hospitalisations (HR=1.01, 95% CI 0.92 to 1.11; 2 studies). The majority of outcomes in the included studies had a serious risk of bias and almost all evaluated outcomes had very low Grading of Recommendation, Assessment, Development and Evaluation (GRADE) evidence.
Influenza vaccination was associated with a significant decrease in all-cause mortality risk in patients with HF.
尽管几十年来治疗方法不断进步，但心力衰竭（HF）仍是一种发病率、死亡率和经济负担都很高的疾病。流感感染是心血管（CV）事件的一个重要诱因，包括 HF。流感疫苗接种已被证明可降低冠心病患者的 CV 死亡率，但在 HF 患者中的效果仍不清楚。因此，我们进行了一项系统评价，以评估流感疫苗接种对 HF 患者的发病率和死亡率的影响。
检索了 MEDLINE、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、卫生技术评估和 PsycINFO 数据库（2018 年 12 月），以评估评估 HF 患者中流感疫苗接种与非疫苗接种对照组相比的纵向研究。根据 ROBINS-I 工具评估偏倚风险。我们进行了随机效应荟萃分析，以估计合并的 HRs 及其 95%置信区间，并使用 I 统计量评估异质性。
纳入了 6 项评估 179158 例 HF 患者的队列研究进行荟萃分析。流感疫苗接种与全因死亡率降低相关（HR=0.83；95%CI 0.76 至 0.91；I=75%）。在汇总分析中，流感疫苗接种对 CV 死亡率（HR=0.92，95%CI 0.73 至 1.15；2 项研究）和全因住院率（HR=1.01，95%CI 0.92 至 1.11；2 项研究）的影响无统计学意义。纳入研究的大多数结局存在严重的偏倚风险，几乎所有评估的结局的证据等级均为极低（GRADE）。
流感疫苗接种与 HF 患者的全因死亡率降低显著相关。
