Key result
Omicron-era COVID-19 hospitalization linked to ~0.6% lower 1-year major cardiovascular risk vs. pre-Omicron.
Why the study?
The excess burden of morbidity and mortality caused by influenza infection in patients with heart failure at a population level was less well characterized.
Does COVID-19 hospitalization during the Omicron era carry a different risk of major adverse cardiovascular events at 1 year compared to the pre-Omicron era or historical influenza in older adults?
Cohort (n=1,184,182)
Yes
Does COVID-19 hospitalization during the Omicron era carry a different risk of major adverse cardiovascular events at 1 year compared to the pre-Omicron era or historical influenza in older adults?
Effect estimate: RD -0.6% (95% CI -0.8% to -0.3%)
Absolute Event Rate: 48.8% vs 49.3%
Absolute Risk Reduction: 0.6%
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These data serve to further reinforce current guidelines and underscore the importance of high vaccination coverage of HF patients. The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure recommends that in HF patients, vaccinating against respiratory illnesses is reasonable to reduce mortality.”
“The study by Modin et al in this issue of JACC is the first to provide robust quantitative epidemiological data on the excess burden of mortality and hospitalizations caused by seasonal influenza in patients with established heart failure. Using time-series methodology that is transparently described, the authors convincingly show that from 2010 to 2018, spanning 8 influenza seasons, seasonal influenza accounted for 2.6% of all all-cause deaths, 2.9% of all cardiovascular death, and 5% of all hospitalizations for influenza or pneumonia, whereas heart failure hospitalizations and cardiovascular hospitalizations remained at the same level.”
Despite lower in-hospital mortality than the pre-Omicron era, older adults hospitalized with COVID-19 during the Omicron era face significantly higher post-discharge risks of cardiovascular events, particularly heart failure, compared to historical influenza.
BACKGROUND: Influenza virus may cause severe infection in patients with heart failure. It is known that influenza infection is associated with increased morbidity and mortality in patients with heart failure. However, less is known about the excess burden of morbidity and mortality caused by influenza infection in patients with heart failure at a population level. OBJECTIVES: The purpose of this study was to estimate the excess burden of morbidity and mortality as determined by annual excess number of deaths and hospitalizations associated with influenza infection in patients with heart failure in Denmark. METHODS: We collected nationwide data on weekly number of deaths and hospitalizations among patients with heart failure in Denmark and weekly estimates of influenza circulation as determined by the proportion of positive influenza samples analyzed at all Danish Hospitals. These data were correlated in a time series linear regression model, and this model was used to estimate the annual excess number of deaths and hospitalizations attributable to influenza circulation among patients with heart failure in Denmark. The model also included data on weekly mean temperature and restricted cubic spline terms to account for seasonality and trends over time. RESULTS: Data were available from 2010 to 2018 encompassing 8 influenza seasons with an annual mean of 25,180 samples tested for influenza at Danish hospitals. Among an annual mean of 70,570 patients with heart failure, our model estimated that influenza activity was associated with an annual excess of 250 all-cause deaths (95% CI: 144-489 deaths) corresponding to 2.6% of all all-cause deaths (95% CI: 1.5%-5.1%) in patients with heart failure. Similarly, influenza activity was associated with an annual excess of 115 cardiovascular deaths (95% CI: 62-244 deaths) corresponding to 2.9% of all cardiovascular deaths (95% CI: 1.5%-6.1%). Influenza activity was also associated with an annual excess of 251 hospitalizations for pneumonia or influenza (95% CI: 107-533 hospitalizations) corresponding to 5.0% of all hospitalizations for pneumonia or influenza. CONCLUSIONS: Our results indicate that influenza activity likely causes substantial morbidity and mortality among patients with heart failure. Notably, our study suggests that approximately 2.6% of all deaths and 5.0% of all hospitalizations with influenza or pneumonia may be attributed to influenza in patients with heart failure.
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Modin et al. (2024) conducted a cohort in COVID-19 (n=1,184,182). COVID-19 hospitalization during the Omicron era vs. COVID-19 hospitalization during the pre-Omicron era was evaluated on Composite of death from any cause and hospitalization for acute myocardial infarction, stroke/transient ischemic attack, pulmonary embolism, deep vein thrombosis, decompensated heart failure, or cardiac arrest at 1 year (RD -0.6%, 95% CI -0.8% to -0.3%). Hospitalization for COVID-19 in the Omicron era was associated with a slightly lower standardized 1-year risk of the primary composite outcome compared to the pre-Omicron era (RD -0.6%).
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