Dermenchyan Anna, Choi Kristen R, Bokhoor Pooya R, Cho David J, Delavin Nina Lou A, Chima-Melton Chidinma, Han Maria A, Fonarow Gregg C
Department of Medicine, Quality, University of California, Los Angeles, CA, United States.
School of Nursing, University of California, Los Angeles, CA, United States; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, United States.
Vaccine. 2025 Feb 6;46:126682. doi: 10.1016/j.vaccine.2024.126682. Epub 2025 Jan 1.
Heart failure affects people of all ages and is a leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are common causes of hospitalizations in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide significant protection against preventable respiratory infections. Despite being an easily accessible intervention, prior studies suggest vaccines are underused in patients with heart failure.
An observational study of 5089 adults with heart failure was conducted using data from an integrated, multicenter, academic health system in Southern California from 2019 to 2022. Logistic regression models were used to determine the rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure preserved ejection fraction [HFpEF], heart failure mildly reduced ejection fraction [HFmrEF], and heart failure reduced ejection fraction [HFrEF], and identify whether heart failure phenotype is associated with vaccination status.
Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 58.0 % of patients had received an influenza vaccine, 76.2 % had received a pneumococcal vaccine, and 83.3 % had received a COVID-19 vaccine. There were no sex-based differences by vaccination status. Differences were seen within age, race/ethnicity, insurance type, whether the patient was a member of an Accountable Care Organization (ACO), primary language, Social Vulnerability Index (SVI) score, clinician type, and number of comorbidities. Patients with HFpEF and HFmrEF had higher vaccination rates than HFrEF. In adjusted models, patients with HFrEF had lower odds of being vaccinated for influenza (aOR = 0.75, 95 % CI = 0.66-0.86), pneumococcal (aOR = 0.65, 95 % CI = 0.55-0.75), and COVID (aOR = 0.74, 95 % CI = 0.62-0.89) compared to patients with HFpEF.
Patients with HFrEF had the lowest levels of respiratory vaccination compared to other specified heart failure categories. Interventions are needed to increase vaccination education and offerings, especially to patients with HFrEF.
心力衰竭影响所有年龄段的人群，在美国大多数种族和族裔群体中，它是男性和女性死亡的主要原因。感染是心力衰竭患者住院的常见原因，其中呼吸道感染最为常见。疫苗接种可有效预防可预防性呼吸道感染。尽管疫苗接种是一种易于实施的干预措施，但先前的研究表明，心力衰竭患者对疫苗的使用率较低。
利用2019年至2022年南加州一个综合、多中心学术医疗系统的数据，对5089名成年心力衰竭患者进行了一项观察性研究。采用逻辑回归模型确定心力衰竭患者群体（射血分数保留的心力衰竭[HFpEF]、射血分数轻度降低的心力衰竭[HFmrEF]和射血分数降低的心力衰竭[HFrEF]）中流感、肺炎球菌和新冠病毒疫苗的接种率，并确定心力衰竭表型是否与疫苗接种状况相关。
流感疫苗、肺炎球菌疫苗和新冠病毒疫苗的接种率各不相同。在这三种呼吸道疫苗中，58.0%的患者接种了流感疫苗，76.2%的患者接种了肺炎球菌疫苗，83.3%的患者接种了新冠病毒疫苗。按疫苗接种状况划分，不存在基于性别的差异。在年龄、种族/族裔、保险类型、患者是否为责任医疗组织（ACO）成员、主要语言、社会脆弱性指数（SVI）评分、临床医生类型和合并症数量方面存在差异。HFpEF和HFmrEF患者的疫苗接种率高于HFrEF患者。在调整后的模型中，与HFpEF患者相比，HFrEF患者接种流感疫苗（调整后比值比[aOR]=0.75，95%置信区间[CI]=0.66-0.86）、肺炎球菌疫苗（aOR=0.65，95%CI=0.55-0.75）和新冠病毒疫苗（aOR=0.74，95%CI=0.62-0.89）的几率较低。
与其他特定心力衰竭类别相比，HFrEF患者的呼吸道疫苗接种水平最低。需要采取干预措施，加强疫苗接种教育并提供更多接种机会，尤其是针对HFrEF患者。
