Advisory: Heart patients need flu vaccine

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Flu shots for patients with heart disease could prevent hundreds of deaths.

The American Heart Association and the American College of Cardiology are asking heart doctors to do something they may not normally do — give flu shots to their patients.

The reason is that patients with cardiovascular disease are more likely to die from influenza than patients with any other chronic condition, says the new AHA/ACC scientific advisory.

Patients with cardiovascular disease, however, should not get the nasal-spray flu live vaccine because it can cause influenza in this high-risk population.

Studies have found that annual flu vaccinations can prevent death in adults and children with chronic conditions of the cardiovascular system. But only one in three adults with cardiovascular disease was vaccinated against flu in the last year.

"If we vaccinated at least 60 percent of the 13.2 million people with coronary heart disease in the United States against influenza, we could prevent hundreds of deaths and thousands of cases of flu each year," said Dr. Matthew M. Davis, lead author of the advisory and associate professor of pediatrics, internal medicine and public policy at the University of Michigan in Ann Arbor, Mich.

The target goal set by the U.S. Department of Health and Human Services is to vaccinate 60 percent of people with heart disease under age 65, and 90 percent of everyone 65 and older, many of whom have heart disease, Dr. Davis said.

Deaths, hospitalizations

Overall, influenza is responsible for 36,000 deaths and 225,000 hospitalizations in the United States each year. People with cardiovascular disease are particularly vulnerable, because the flu can exacerbate heart disease symptoms directly and can also lead to conditions such as viral or bacterial pneumonia that cause flare-ups of cardiovascular disease, he said.

In May 2006, new AHA/ACC joint guidelines on preventing recurrent cardiovascular events recommended an annual flu shot for all people with cardiovascular disease.

"Influenza vaccination is now recommended with the same enthusiasm as cholesterol and blood pressure control and other modifiable risk factors for cardiovascular disease," the advisory noted.

The strongest evidence of a protective effect comes from the FLUVACS trial. In that trial, 301 people hospitalized for either a heart attack or an angioplasty and stent procedure to open clogged arteries were randomly assigned to receive flu vaccine or remain unvaccinated.

Over the next year, among those who did not get vaccinated 23 percent had died of heart disease, had a nonfatal heart attack or developed severe ischemia (insufficient blood supply to the heart tissue), compared with only 11 percent of their vaccinated counterparts.

Missed opportunity

A visit to the cardiologist presents a good, but often missed, opportunity to get vaccinated, Dr. Davis said. The advisory authors said immunization isn't perceived as part of a typical cardiology practice. But the most effective way to increase the number of cardiovascular patients vaccinated is to have flu vaccine available in all cardiology practices and to have physicians strongly recommend the vaccine to their patients. Most insurance plans cover flu vaccinations.

The advisory urges:

* Cardiologists to stock flu vaccine for their patients in their clinics and strongly encourage influenza immunization.

* Patients with cardiovascular disease to get a flu vaccination (given by injection) every year by the end of November. Receiving a shot in January or even later should still protect from flu, as the flu season in the United States typically peaks in January, February or March.

Tuesday, September 19, 2006