RSV may worsen clinical outcomes in HF patients

A retrospective analysis presented at HSFA ASM 2024 shows that respiratory syncytial virus (RSV) infection in individuals with heart failure (HF) is associated with greater adverse clinical outcomes.

“Individuals suffering from HF are more vulnerable to consequences connected to RSV, such as acute decompensated HF and secondary pneumonia,” said the researchers.

With the hypothesis that hospital outcomes will be higher in HF patients with RSV infection, the investigators conducted a retrospective analysis of the National Inpatient Sample data between 2016 and 2020. They evaluated patients aged ≥18 years who were admitted with RSV, and these patients were stratified by HF diagnosis. Of the 183,985 primary HF hospitalizations included in the analysis, 10,805 (5.9 percent) patients had a diagnosis of HF. [Carcamo, F, et al, HFSA ASM 2024]

Study outcomes were in-hospital mortality, acute kidney injury, acute kidney injury requiring dialysis, acute respiratory failure, and acute respiratory failure requiring mechanical ventilation.

After propensity score matching with logistic regression, except for in-hospital mortality (p=0.223), all other in-hospital outcomes were significantly higher among participants who were infected with RSV (p<0.001 for all).

The unadjusted odds ratios were as follows: 1.06 (95 percent confidence interval [CI], 1.02–1.12) for acute kidney injury, 1.03 (95 percent CI, 0.75–1.14) for acute kidney injury requiring dialysis, 1.42 (95 percent CI, 1.31–1.56) for acute respiratory failure, and 1.59 (95 percent CI, 1.42–1.71) for acute respiratory failure requiring mechanical ventilation.

The findings correlate with the results of a study on individuals hospitalized with acute respiratory illness due to RSV, wherein those with underlying cardiovascular disease had higher odds of having a severe hospital outcome, including mechanical ventilation. [J Infect Dis 2013;208 Suppl 3:S197-S206]

A major public health concern

Studies have shown that RSV is considered an important cause of lower respiratory tract infection in older adults and among those who have underlying chronic cardiopulmonary disease. [J Infect Dis 1995;172:389-394; J Infect Dis 1996;174:456-462]

According to a report from the American Heart Association, about two-thirds of hospitalized adults with RSV have underlying cardiovascular disease, and up to a quarter of adults hospitalized for RSV deal with cardiovascular complications, including worsening congested HF, acute coronary syndrome, and arrhythmias. [https://www.heart.org/en/health-topics/rsv#, accessed October 29, 2024]

“RSV is a major public health concern … The findings of this study highlight the necessity for intensified endeavours to enhance RSV vaccination rates and create vaccines that offer more comprehensive immunity,” the researchers concluded.

More studies are warranted to shed light on the association between RSV and cardiovascular disease. Another report suggested that with the increased risk of illness and morbidity due to RSV infection in older patients and those with underlying cardiac disease, these patients “may represent an important target population for a future RSV vaccine, other prevention strategies, and RSV antiviral treatment.” [J Am Coll Cardiol 2018;71:1574-1583]