COVID-19 incidence and vaccination against SARS-Cov-2, influenza, and pneumococcal disease in patients with heart failure
Authors: Dabrowska K , Wojcicki K , Piwarski M , Rzepiela L , Wezyk-Wylegala N , Plonka J , Gierlotka M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The risk of a severe course of COVID-19 infection increases with age and body weight, is higher in men and in the chronically ill. Patients with cardiovascular diseases, including heart failure (HF), are at risk of severe (various) infections with a higher risk of complications leading to death. The current guidelines of the European Society of Cardiology recommend prophylactic vaccinations in this group of patients against both SARS-COV-2 and other pathogens.

Purpose
The aim of the study was to analyze the vaccination coverage against pneumococcus, influenza and COVID-19, as well as to assess the incidence and course of COVID-19 infections in the population of patients with HF hospitalized after an episode of acute heart failure (AHF) between 03.2021 and 03.2022.

Methods
As a part of the prospective Acute Heart Failure Registry (OP-AHF), in the period from 06.2019, data were obtained from 122 patients hospitalized in the ICCU. Inclusion criteria were hospitalization for AHF and the need to use at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. Data on vaccinations against COVID-19 (a/C19), influenza (a/I) and pneumococcus (a/P), as well as COVID-19 incidence, were collected in a 12-month follow-up from 90 patients.

Results
COVID-19 infection occurred in 27% of patients (24 of 90 patients). In the studied population, fewer cases of the disease occurred in patients over 65 years of age compared to the younger ones (20% vs 36%, p = 0.08) and a significant proportion of them were male (96% vs 4% women).Among patients with a history of COVID-19 infection [C19(+)] compared to patients without infection [C19(-)], slightly more patients were active smokers (42% vs 39%, p = 0.85), more had diabetes (42% vs 27%, p = 0.19) and hypertriglyceridemia (25% vs 8%, p = 0.03). Patients C19(+) had a higher BMI (34 vs 29 in C19(-), p = 0.01) and lower left ventricle ejection fraction at discharge (33 vs 40, p = 0.18). The most common etiologies of HF in C19(+) patients were ischemic (10 of 24 patients, 42%) and valvular (10 of 24 patients, 42%).
The vaccination coverage a/C19 in the whole group of patients was 69% (62 out of 90), of which a higher percentage of vaccinations was in patients over 65 years of age (75% vs 62%, p = 0.19). The a/I vaccination rate was 11%, with a slightly lower percentage in patients over 65 years of age (10% vs 13%, p = 0.65). Among the studied patients, 58% (52 of 90) were vaccinated with both a/C19 and a/I. However, all patients vaccinated a/I were also vaccinated a/C19. None of the examined patients was vaccinated a/P.

Conclusion
The COVID-19 pandemic and the widely available information on cardiovascular complications resulted in an increase in vaccination among a group of patients at high risk for complications. However, there is still unsufficient awareness of the need for influenza and pneumococcal vaccination as a prevention of serious post-infection complications.