COVID-19 vaccines: strong drug in HF but withdrawal delays

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Vaccination against SARS-CoV-2 offers significant benefits in people with: heart failure but many of these at-risk patients are hesitant to get vaccinated, new research suggests.

Unvaccinated patients were three times more likely to die from COVID-related disease than those who were fully vaccinated (hazard ratio [HR], 0.36; 95% CI 0.30 – 0.43) or vaccine boosted (HR 0.33; 95% CI 0.23 – 0.48).

There was no significant difference in mortality between partially vaccinated versus unvaccinated patients (HR 0.87; 95% CI 0.68 – 1.12).

Unvaccinated or partially vaccinated patients were also significantly more likely to be hospitalized (incidence ratio [IRR]0.68) and require IC admission (IRR, 0.63), even after adjusting for relevant factors such as age, gender, race/ethnicity, obesitydiabetes and lung disease.

“Despite conservative statistical approaches, the risk ratios were striking,” lead author Anuradha Lala, MD, Icahn School of Medicine at Mount Sinai in New York City, said. | Medscape Cardiology.

Although the study had insufficient power to detect differences between patients who received boosted versus fully vaccinated, COVID-19 vaccines appeared to have the most benefits for those who were vaccinated, followed by the fully vaccinated, partially vaccinated, and unvaccinated.

“This is observational data, so one cannot prove causality, but it certainly underscores the profound protective effects of vaccination against COVID-19 in patients with heart failure,” she said.

Respond to the study for | Medscape Cardiology, Ileana L Piña, MD, MPH, Thomas Jefferson University, Philadelphia, Pennsylvania, said this is a single-center study of patients in the Epic record system, but was conducted during an active period of the New York pandemic.

“I think this should be some consolation for the heart failure population to get vaccinated because there’s definitely an impact on how you’ll do without excess mortality,” she said.

The results, published on June 9th in the diary of heart failure, were drawn from 7,094 patients diagnosed with heart failure (HF) who had visited the Mount Sinai Health System between January 1, 2021 and January 24, 2022. They were on average 73 years old and 48% were female.

Based on a record summary, 31% of patients had been fully vaccinated with two doses and 14.8% had received a booster, according to then-guidelines from the Centers for Disease Control and Prevention.

An additional 9.1% of patients were partially vaccinated with one dose, while by January 2022 a full 45% were unvaccinated.

Of the 904 patients who died during a mean follow-up of 9 months, 73.4% were not or only partially vaccinated.

Previous work has shown that patients with HF are at greater risk of complications when infected with COVID and are nearly twice as likely to die than patients without HF. However, the corollary of how protective COVID-19 vaccines are in HF was lacking and was a key driver for starting the study, Lala noted.

Early in the vaccine rollout, professional associations such as the Heart Failure Society of America issued statements provide certainty about vaccine safety, but the fear remains.

“As a cardiologist for heart failure, I see patients in the clinic all the time who are afraid of getting the vaccine,” Lala said. “And when I research and ask why, many of them say, ‘I already have a history of heart failure and I heard reports of myocarditis and that the vaccine could affect my heart in a negative way. So I don’t want to take that risk.’ †

“It was difficult to convince some patients that the cardiovascular benefits of vaccination significantly outweigh the risk of complications because there was no concrete evidence specific to the heart failure population,” she said.

What the retrospective study cannot answer is whether concerns about myocarditis resonate more in patients with HF or other cardiovascular disease. Patients with chronic diseases are generally more likely to be vaccinated than the general public.

On the other hand, there is a lot of misinformation and studies have reported that the risk of myocarditis is about 0.24% with a SARS-CoV-2 infection versus 0.002%, or about 100 times less, with a COVID-19 vaccine Lala noted.

“My personal view is that myocarditis, as a result of vaccination, has become sensational and not contextualized with the relative risk of myocarditis and other complications due to COVID-19,” she said.

Piña said she has encountered similar resistance and misconceptions. “They say I don’t want viruses in my system because they think the vaccine contains a live virus, which is something else we have to expel — what the vaccine is made of,” she said.

To determine whether side effects were related to COVID, the researchers conducted a secondary analysis of 1,767 patient contacts with at least one positive test for SARS-CoV-2.

Results show that SARS-CoV-2 positivity was associated with higher hospitalizations (IRR, 1.67), IC admission (IRR, 2.01) and mortality (HR, 3.39; p value for all < .001).

In patients with positive tests, vaccinated status was associated with lower hospital admissions (HR 0.83; p = .02), IC incorporation (IRR, 0.57; p = .009) and mortality (HR, 0.35; p = .045) compared to the unvaccinated status.

“COVID-19 is still going on, so we can’t get complacent,” Lala said. “I think we often blame the patient, ‘Oh, they refused vaccination.’ But I think we need to better understand what the barriers are in their minds to getting vaccinated, what the fears are, what the resistance is, and then we need to try to fill those gaps with knowledge and data that applies to them. .”

The authors note that the study did not record seropositivity, hospitalization, or death in other hospital systems; did not distinguish based on whether patients had HF with conserved or reduced ejection fraction (HFpEF/HFrEF) or by stage of HF; and that data on specific treatments for HF or COVID-19 were not available.

“They didn’t differentiate between HFrEF and HFpEF, but if you look at the population, they’re in the average age of their 70s, so it’s the population that you know can get sicker if they have heart failure.” noted Pina. “Age alone makes it a vulnerable population, which makes this even more valuable.”

“And they had plenty of women. Most heart failure studies have only 20% women on average, and here they had 48% women, which tells me they probably have a lot of HFpEFs here too,” she said. “So the message to the public is: Please get vaccinated. Your risks are much better if you do it right.”

The research was supported internally. Lala has received personal compensation from Zoll, outside of the work submitted. Piña reported being a member of an advisory board for ViFor Pharma.

J card failed. Published online June 9, 2022. Entire text

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