Improving vaccine uptake after myocardial infarction: results of an opportunistic counselling strategy in cardiac rehabilitation

Background Influenzavirus, SARS-CoV-2 (COVID-19), and Streptococcus pneumoniae vaccination (Flu-V / COV19-V / SPn-V) reduce the risk of adverse cardiovascular events in patients with myocardial infarction (MI). However, vaccination coverage remains low even in this high-risk population. Purpose We aim to evaluate the effect of an opportunistic vaccination advice (OVA) intervention for Flu-V, COV19-V and SPn-V in MI patients enrolled in a Cardiac Rehabilitation Program (CRP). Methods MI patients attending our local CRP between November 2021 and January 2025 were included in a prospective registry. We retrospectively reviewed vaccination rates for Flu-V, COV19-V, and SPn-V across the 2022–23, 2023–24, and 2024–25 campaigns. All post-MI patients were considered eligible for these vaccines according to the local schedule. During the 2024-25 campaign, an OVA intervention was implemented for patients scheduled for outpatient CRP visits using promotion posters, printed materials, and brief physician advice. The impact of OVA was assessed by comparing 2024–25 vaccination rates in OVA receivers versus non-receivers. Results A total of 279 patients were included (mean age 62.26±10.71 years; 82.4% men). Hypercholesterolemia (86%), hypertension (57%), and smoking habits (49.8%) were the most prevalent cardiovascular risk factors. Across the three campaigns there was a non-significant upward trend in Flu-V (40.0%, 41.6%, 48.4%) and COV19-V (30.0%, 35.0%, 40.1%). SPn-V uptake increased significantly in 2024–25 (26.9% vs. 8.1% and 6.3% in prior years; p<0.001). In the 2024-25 campaign, nearly half of patients did not receive any vaccine (n=135, 48.4%), 9.3% received only one vaccine, 21.1% received two vaccines, and 21.1% received all three vaccines. Unvaccinated patients were younger (59.12±9.66 vs.65.2±10.85 years, p<0.001), less often hypertensive (48.9% vs. 64.6%, p=0.008), more frequently male (87.4% vs. 77.8%, p=0.04), and more often previous smokers (58.5% vs. 41.7%, p=0.005). During 2024-25, we observed a significant increase in vaccination rates in OVA receivers (n=185) vs. non-receivers (n=94) for Flu-V (54.1% vs. 37.2%, p=0.008), COV19-V (45.9% vs. 28.7%, p=0.006), and SPn-V (33.5% vs. 12.8%, p<0.001). Conclusion An opportunistic vaccination advice intervention delivered within Cardiac Rehabilitation significantly increased uptake of Flu-V, COV19-V and SPn-V in post-MI patients. Despite this improvement, overall vaccination coverage remained suboptimal, indicating the need for additional strategies to enhance immunization in this vulnerable group.Immunization rates. Flu-V, COV19-V and SPn-VEffect of opportunistic vaccination advice