Heart Failure Mortality Outcomes Improve Following COVID-19 Vaccination

Heart failure (HF) mortality outcomes were superior among patients fully vaccinated and boosted against SARS-CoV-2 infection compared with unvaccinated and partially vaccinated patients, according to new research published today in Journal of Cardiac Failure.

Diving deeper, among persons with HF, the risk of death was 3 times higher in unvaccinated and partially vaccinated individuals. These patients also had a 15% greater likelihood of hospitalization due to SARS-CoV-2 infection and a doubled risk of intensive care unit (ICU) admission.

These findings are especially important in light of patient fears of myocarditis, which is a known, albeit rare, adverse effect (AE) of COVID-19 vaccination. What patients may not understand, however, is that myocarditis is more common with SARS-CoV-2 infection.

“I launched this study because our HF patients often express fear of getting the COVID-19 vaccine after hearing reports of vaccine-related myocarditis, which would cause another cardiac setback for them,” said corresponding author Anuradha Lala, MD, director of HF research and an associate professor of medicine (cardiology) at the Icahn School of Medicine at Mount Sinai, in a statement. “Until now, we didn’t have concrete evidence to show the substantial risks of being unvaccinated.”

This retrospective cohort study analyzed outcomes from January 1, 2021, through January 24, 2022, among 7094 patients with HF (mean [SD] age, 73.3 [14.5] years; 48% female) receiving care at Mount Sinai through regular office visits, emergency department (ED) visits, or hospitalization. A majority were fully (31.0%; n = 2200) or partially (9.1%; n = 645) vaccinated or were boosted (14.8%; n = 1053). Just over 45% (3196) were unvaccinated. Sixty-three percent had Medicare coverage, and the most common comorbidities were other cardiovascular diseases (CVDs)—defined for this study as coronary artery disease, history of myocardial infarction, atrial fibrillation, and peripheral vascular disease—among 77.9%.

During the investigators’ mean (SD) follow-up of 276.5 (104.9) days, there was a 67% reduced risk of death among vaccine-boosted patients (HR, 0.33; 95% CI, 0.23-0.48) and a 64% reduced risk among fully vaccinated patients (HR, 0.36; 0.30-0.43) vs those who remained unvaccinated.

“No difference was observed between those who were unvaccinated or only partially vaccinated,” the authors wrote (HR, 0.87; 95% CI, 0.68-1.12).

Patients for inclusion in this study were identified using International Classification of Diseases, Tenth Revision codes for hospitalization billing or an encounter diagnosis of HF. Mechanical circulatory support, orthotopic heart and other solid organ transplant, and first vaccination before the study began precluded participation.

Analyses also revealed these findings:

• 32% had type 2 diabetes
• 12.7% died
• 73.4% of those who died were unvaccinated or partially vaccinated
• 32% reduced risk of hospitalization (incidence rate ratio [IRR], 0.68; 95% CI, 0.65-0.71) in the boosted and fully vaccinated participants
• 37% reduced risk of ICU admission (IRR, 0.63; 95% Ci, 0.58-0.68) in the boosted and fully vaccinated participants
• Obesity (P = .008); hypertension, pulmonary disease, diabetes, smoking history (P < .001); and CVD (P < .001) were more common in the boosted and fully vaccinated participants
• Older age, White race, and Medicare coverage were more common in the boosted and fully vaccinated participants (P < .001)

A secondary analysis looked at AEs potentially related to positive SARS-CoV-2 test results, and this found 67%, 101%, and 239% greater risks of hospitalization, ICU admission, and death, respectively, associated with such findings. In addition, among those testing positive even though they were vaccinated, there were lower rates of hospitalization (HR, 0.83; 95% CI, 0.78-0.89), ICU admission (HR, 0.57; 95% CI, 0.37-0.86), and death (HR, 0.35; 95% Ci, 0.12-0.97) compared with unvaccinated patients who tested positive.

“COVID-19 vaccination was associated with significant reduction in all-cause hospitalization rates and mortality,” the authors concluded, “lending further evidence to support the importance of its implementation in the high-risk population of patients living with HF.”

However, there were several limitations to their findings, and they included that the investigators did not differentiate among the types or stages of HF and that data on how HF and COVID-19 were treated were not available.

Reference

Johnson KW, Patel S, Thapi S, et al. Association of reduced hospitalizations and mortality among COVID-19 vaccinated patients with heart failure. J Card Fail. Published online June 9, 2022. doi:10.1016/j.cardfail.2022.05.008