Cardiac events common among individuals hospitalized for RSV infection

One in 10 individuals hospitalized for a respiratory syncytial virus (RSV) infection has a concurrent acute cardiovascular event, and this number is higher than that observed among individuals hospitalized for a COVID-19 infection, according to a study from Singapore.

Analysis of data from an electronic health record–based healthcare claims database showed that of the 2,148 patients hospitalized for RSV, 234 (10.9 percent) had an acute cardiovascular event. The most common event was dysrhythmia (n=99), followed by heart failure (n=66) and ischaemic heart disease (n=61). [JAMA Netw Open 2025;8:e2511764]

Patients with vs without pre-existing cardiac history had more than twofold higher odds of an acute cardiovascular event (adjusted odds ratio [AOR], 2.53, 95 percent confidence interval [CI], 1.84–3.48). Furthermore, the occurrence of a cardiovascular event increased the odds of severe RSV requiring intensive care unit admission (AOR, 2.36, 95 percent CI, 1.21–4.62).

RSV vs COVID-19, influenza

Looking at hospitalizations for other respiratory viral infections, the odds of any acute cardiovascular event were higher for patients hospitalized for RSV than for those hospitalized for COVID-19 regardless of receipt of a booster dose (boosted: AOR, 1.31, 95 percent CI, 1.12–1.54; unboosted: AOR, 1.58, 95 percent CI, 1.24–2.01). The same held true for individual cardiac events, such as dysrhythmias and heart failure.

Meanwhile, the odds of a cardiovascular event did not significantly differ between patients hospitalized for RSV and those hospitalized for influenza stratified by vaccination status. However, a notable exception was observed in the postpandemic period (2023–2024), wherein patients with RSV hospitalizations had twofold greater odds of heart failure compared with those hospitalized for vaccine-breakthrough influenza (AOR, 2.09, 95 percent CI, 1.21–3.59).

Results were consistent in sensitivity analysis restricting the population to adults at least 60 years of age.

The analyses included a total of 32,960 respiratory viral infection-related hospitalizations (mean patient age 66.58 years, 51.7 percent female), of which 14,389 were for influenza, 16,423 were for COVID-19, and 2,148 were for RSV.

RSV vaccination crucial

“Year-round RSV transmission has been described in Singapore, given its humid and rainy tropical climate, [and] RSV burden in older adults is comparable to that in younger children,” the investigators said.

“Cardiac manifestations of RSV are hypothesized to arise directly from myocardial injury or indirectly via a postinflammatory response and increased cardiovascular strain attributed to pulmonary disease. Dysrhythmia was the most frequently encountered cardiac event after RSV hospitalization, with atrial fibrillation most commonly reported,” they added.

In light of the findings of the study, the investigators emphasized the need to increase vaccine awareness and vaccination uptake among adults with pre-existing cardiac conditions. This is particularly so, considering the proven ability of influenza and COVID-19 vaccines to prevent severe illness and hospitalization, the high incidence of congestive heart failure during RSV and influenza hospitalizations, and the confirmed safety of simultaneously administering RSV and influenza vaccines to high-risk heart failure patients. [Clin Infect Dis 2024;78:1065-1072; Eur J Heart Fail 2025;27:152-165; Clin Infect Dis 2023;76:1980-1988; Vaccine 2024;42:2937-2940]

“Given recent availability of RSV vaccination, older adults with pre-existing cardiac history should be prioritized for vaccination against vaccine-preventable respiratory viral infections. Patients with a prior cardiac history might also benefit from more intensive clinical evaluation and monitoring for cardiac events during RSV hospitalization in light of greater risk,” they said.