Association of RSV Vaccination With Clinical Outcomes in Older Adults With Heart Failure: A Propensity‐Matched Analysis

BACKGROUND: Respiratory syncytial virus (RSV) is increasingly recognized as a trigger for adverse outcomes in older adults with heart failure (HF). Following FDA approval of RSV vaccines for adults ≥ 60 years in 2023, real-world evidence in HF populations remains limited. METHODS: We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network. Adults ≥ 60 years with HF were identified and stratified by RSV vaccination status from May 1, 2023, to January 01, 2026. Propensity score matching (1:1) was performed. The primary outcome was all-cause mortality. Secondary outcomes included respiratory failure, healthcare utilization, and cardiovascular events. RESULTS: After PSM, 777 vaccinated and 777 unvaccinated HF patients were analyzed. All-cause mortality (HR 0.51, 95% CI, 0.33-0.79) and ICU admissions were significantly lower in vaccinated patients (2.7% vs. 5.8%, HR 0.46, 95% CI 0.25-0.86), while healthcare utilization was significantly higher in the vaccinated cohort (HR 1.85, 95% CI 1.65-2.08). No significant differences were observed in respiratory failure (7.3% vs. 9.4%, HR 0.87, 95% CI 0.61-1.23), inpatient or emergency visits (29.9% vs. 35.1%, HR 0.97, 95% CI 0.81-1.16), HF exacerbations, myocardial infarction, or stroke. Age-stratified subgroup analyses (60-75 and 75-90 years) showed consistent findings, with no significant cardiovascular differences and significantly higher healthcare utilization in vaccinated patients across both age groups. CONCLUSIONS: In older adults with HF, RSV vaccination was associated with lower mortality and fewer ICU admissions, without a corresponding reduction in overall inpatient/emergency use or acute-care utilization. These findings are hypothesis-generating and may reflect prevention of severe respiratory illness.