Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA Intern Med. 2024 Jun 1;184(6):602-611. doi: 10.1001/jamainternmed.2024.0212.
Respiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection.
To describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected through clinician-directed laboratory testing. Cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (annually from 2014-2015 through 2017-2018 and 2022-2023) were examined to estimate the weighted period prevalence and 95% CIs of acute cardiac events.
Acute cardiac events, identified by International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification discharge codes, and discharge summary review.
Severe disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events.
The study included 6248 hospitalized adults (median [IQR] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection. 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. Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had 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).
In this cross-sectional study over 5 RSV seasons, nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.
重要性：呼吸道合胞病毒 (RSV) 感染可导致老年人严重的呼吸道疾病。与流感和 SARS-CoV-2 感染相比，人们对 RSV 疾病的心脏并发症了解较少。
目的：描述在 50 岁及以上成年人因 RSV 感染住院期间发生急性心脏事件的患病率和严重程度。
设计、地点和参与者：这项横断面研究分析了 RSV 住院监测网络的监测数据，该网络对通过临床医生指导的实验室检测检测到的 RSV 感染住院患者进行详细的病历摘录。在 12 个州的 5 个 RSV 季节（2014-2015 年至 2017-2018 年以及 2022-2023 年）期间，对 50 岁及以上成年人的 RSV 感染病例进行了检查，以估计急性心脏事件的加权期间患病率和 95%置信区间。
暴露：通过国际疾病分类第 9 版临床修订版或国际疾病分类第 10 版临床修订版出院代码和出院记录审查确定的急性心脏事件。
主要结果和措施：严重疾病结局，包括入住重症监护病房（ICU）、接受有创机械通气或院内死亡。计算调整后的风险比（ARR）以比较有和没有急性心脏事件的患者的严重结局。
结果：该研究纳入了 6248 名患有实验室确诊 RSV 感染的住院成年人（中位数 [IQR] 年龄为 72.7 [63.0-82.3] 岁；59.6%为女性；56.4%有基础心血管疾病）。经历心脏事件的加权估计患病率为 22.4%（95%CI，21.0%-23.7%）。急性心力衰竭的加权估计患病率为 15.8%（95%CI，14.6%-17.0%），急性缺血性心脏病为 7.5%（95%CI，6.8%-8.3%），高血压危象为 1.3%（95%CI，1.0%-1.7%），室性心动过速为 1.1%（95%CI，0.8%-1.4%），心源性休克为 0.6%（95%CI，0.4%-0.8%）。与没有基础心血管疾病的成年人相比，有基础心血管疾病的成年人发生急性心脏事件的风险更高（33.0% vs 8.5%；ARR，3.51；95%CI，2.85-4.32）。在所有因 RSV 感染住院的成年人中，18.6%需要入住 ICU，4.9%在住院期间死亡。与没有急性心脏事件的患者相比，发生急性心脏事件的患者入住 ICU 的风险更高（25.8% vs 16.5%；ARR，1.54；95%CI，1.23-1.93）和院内死亡风险更高（8.1% vs 4.0%；ARR，1.77；95%CI，1.36-2.31）。
结论和相关性：在这项跨越 5 个 RSV 季节的横断面研究中，近四分之一的 50 岁及以上因 RSV 感染住院的成年人经历了急性心脏事件（最常见的是急性心力衰竭），包括 12 名成年人中有 1 名（8.5%）没有记录到潜在的心血管疾病。与没有发生急性心脏事件的患者相比，发生急性心脏事件的患者发生严重结局的风险几乎增加了一倍。这些发现阐明了 RSV 疫苗可用之前 RSV 感染潜在心脏并发症的基线流行病学。
