# RSV in cardiovascular care: When the lungs speak to the heart

Paul Loubet, François Roubille

► To cite this version:

Paul Loubet, François Roubille. RSV in cardiovascular care: When the lungs speak to the heart. Progress in Cardiovascular Diseases, 2025, 92, pp.144-145. 10.1016/j.pcad.2025.07.003. hal-05511394

HAL Id: hal-05511394

https://hal.science/hal-05511394v1

Submitted on 15 Feb 2026

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RSV in cardiovascular care: When the lungs speak to the
heart

Paul Loubet ¹, François Roubille ²

¹ Virulence Bactérienne et Infections Chroniques, INSERM U1047, Univ Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France. Electronic address: paul.loubet@chu-nimes.fr

² Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France.

**Keywords:** Cardiovascular events; RSV; Vaccines.
Respiratory syncytial virus (RSV) has traditionally been considered a pediatric pathogen responsible for bronchiolitis and pneumonia in infants. Over recent decades, however, an emerging body of evidence has documented the substantial impact of RSV among adults, especially the elderly and those living with chronic comorbidities. Cardiovascular (CV) diseases (CVDs) remain the leading cause of mortality worldwide. In this issue, Penders and colleagues provide a comprehensive systematic review on the burden of RSV in adults with CVDs.1 Their findings underscore the need to reconsider clinical assumptions about RSV as a “mild” illness in adulthood and to recognize its relevance as a contributor to CV morbidity and mortality.

This review synthesized data from 62 studies conducted between 2000 and 2023. In hospitalized adults with RSV infection, pooled estimates showed that nearly 28 % had heart failure, 23 % ischemic heart disease, and 44 % non-specified CVD. This is markedly higher than the estimated prevalence of heart failure (1–2 %) and ischemic heart disease (~1.7 %) in the general adult population.2,3 These data reveal that cardiovascular comorbidities are disproportionately represented among adults with severe RSV disease, suggesting both increased susceptibility to infection and greater risk for complications. Such findings are consistent with studies of influenza and SARS-CoV-2, which have demonstrated that viral respiratory infections can precipitate decompensation of heart failure, acute coronary syndromes, and arrhythmias.4

In this respect, RSV behaves not merely as a respiratory pathogen but also as a catalyst of CV events.5 One of the important contributions of this review is its documentation of serious complications. Among adults with CVDs infected by RSV, rates of intensive care unit admission and mechanical ventilation were substantial. Case fatality rates in hospitalized patients reached up to 14.8 % among those with heart failure and 20 % among those with ischemic heart disease. These observations reinforce the clinical impression that RSV infection in this context is frequently severe. Moreover, although most included studies focused on in-hospital outcomes, emerging data suggest the impact of RSV may persist long after discharge. For example, recent analyses have shown rehospitalization rates exceeding 40 % within 12 months after RSV infection, with circulatory diseases among the leading causes of readmission.6 While long-term mortality was less systematically captured, heart failure exacerbation during acute infection has been associated with increased mortality risk over the following year. These results align with recent observational research that assessed the incidence of CV events temporally linked to RSV, such as myocardial infarction, new-onset atrial fibrillation, or stroke occurring in the 14 days following infection.7 However, the true burden of RSV may be underestimated due to limited availability of sensitive testing in routine in patient care and the predominance of inpatient-based research. This is especially concerning for milder cases among community-dwelling adults, which remain understudied and could lead to under recognition and underdiagnosis of RSV-related CV events on a large scale, posing both individual and public health concerns.
The findings of Penders et al. have significant implications for prevention. In the past two
years, RSV vaccines have received regulatory approval for adults over 60 and recently
received an extension for high-risk populations, including adults under 60 with CVDs.8–10
Despite these advances, awareness of RSV risk among clinicians and patients remains
dramatically low, and vaccine uptake falls short of expectations. Given the similarities with
influenza, where yearly immunization is a key part of care for patients with CVD, there is an
opportunity to incorporate RSV vaccination into established preventive strategies.11
However, several areas require further research to guide policy and practice. Prospective
studies capturing outpatient cases are crucial to quantifying the community burden and
defining the clinical spectrum. Data on the incidence of specific CV events linked to RSV are
needed to clarify mechanistic pathways and aid in risk stratification. Studies assessing vaccine
effectiveness on CV outcomes will be crucial to demonstrating the non-respiratory benefits of
RSV vaccines.

In conclusion, this systematic review provides compelling evidence that RSV is much more
than a seasonal nuisance. In adults with CVDs, it is a clinically significant infection that
contributes to acute decompensation, longer hospital stays, and higher mortality risk. As the
preventive landscape advances with effective vaccines, the cardiology and infectious disease
communities should work together to improve preventive care and address existing evidence
gaps. Recognizing RSV as an important CV pathogen is a necessary step toward reducing its
impact on patients living CVDs.

CRediT authorship contribution statement

Paul Loubet: Writing – original draft. François Roubille: Writing – review & editing.

Funding

None.
**Declaration of competing interest**

Paul Loubet has received payment or honoraria for lectures, presentations, speakers bureau, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Janssen, Moderna, Merck Sharp & Dohme, Pfizer, Sanofi Pasteur, Seqirus.

François Roubille has received payment or honoraria for lectures, presentations, speakers bureau, or educational events from Astra Zeneca, Servier, Boehringer, Vifor, Bayer, Pfizer, Novartis, Servier, Novonordisk, Air liquid, Abbott, QuidelOrtho, Newcard, MSD, Sanofi, Alnylam, Zoll, Implicity, GSK, BMS.

**References**

1. Penders Y, Falsey AR, Bhatt DL, et al. Burden and severity of respiratory syncytial virus infection in adults with cardiovascular diseases: a systematic literature review. Prog Cardiovasc Dis. 2025. S0033-0620(25)00088-X.

2. Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail. 2020;22:1342–1356.

3. Khan MA, Hashim MJ, Mustafa H, et al. Global epidemiology of ischemic heart disease: results from the global burden of disease study. Cureus. 2025;12:e9349.

4. Nguyen TQ, Vlasenko D, Shetty AN, et al. Systematic review and meta-analysis of respiratory viral triggers for acute myocardial infarction and stroke. Cardiovasc Res. 2025:cvaf092.

5. Ivey KS, Edwards KM, Talbot HK. Respiratory syncytial virus and associations with cardiovascular disease in adults. J Am Coll Cardiol. 2018;71:1574–1583.
6. Puggina A, Dovizio M, Domnich A, et al. Demographics and clinical burden of disease among RSV-hospitalized older adults in Italy: a retrospective cohort study. Hum Vaccin Immunother. 2025;21:2479334.

7. Lassen MCH, Modin D, Johansen ND, et al. Respiratory syncytial virus and incidence of cardiovascular events. J Am Coll Cardiol. 2025;85:1504–1507.

8. US FDA Approves Expanded Age Indication for GSK’s AREXVY, the First Respiratory Syncytial Virus (RSV) Vaccine for Adults Aged 50–59 at Increased Risk | GSK [Internet]. [cit’e 2025 juill 1];Available from: https://www.gsk.com/en-gb/media/press-releases/us-fda-approves-expanded-age-indication-for-gsk-s-arexvy-the-first-rsv-vaccine-for-adults-aged-50-59-at-increased-risk/; 2024.

9. US FDA Approves Pfizer’s RSV Vaccine for Adults at Increased Risk of the Disease [Internet]. Reuters2024 [cit’e 2025 juill 1];Available from: https://www.reuters.com/business/healthcare-pharmaceuticals/us-fda-approves-pfizers-rsv-vaccine-adults-increased-risk-disease-2024-10-22/.

10. Moderna Receives U.S. FDA Approval for RSV Vaccine, mRESVIA, in Adults Aged 18–59 at Increased Risk for RSV Disease [Internet]. [cit’e 2025 juill 1];Available from: https://investors.modernatx.com/news/news-details/2025/Moderna-Receives-U-S–FDA-Approval-for-RSV-Vaccine-mRESVIA-in-Adults-Aged-1859-at-Increased-Risk-for-RSV-Disease/default.aspx.

11. Heidecker B, Libby P, Vassiliou VS, et al. Vaccination as a new form of cardiovascular prevention: a European Society of Cardiology clinical consensus statement: With the contribution of the European Association of Preventive Cardiology (EAPC), the Association for Acute CardioVascular Care (ACVC), and the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2025:ehaf384.
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