Research Suggests Acute Cardiac Events Are Common in Older Adults Hospitalized With RSV

New study findings published in JAMA Internal Medicine show that acute cardiac events are common among hospitalized older adults with respiratory syncytial virus (RSV) and are associated with severe clinical outcomes.

RSV typically causes mild upper respiratory tract symptoms but can cause severe lower respiratory tract disease in high-risk groups such as older adults. Older age and history of chronic medical conditions, including heart failure and coronary artery disease, are risk factors for severe RSV disease and hospitalization.

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Respiratory viruses as a whole, including influenza and COVID-19, have been associated with acute cardiovascular disease and mortality based on findings from ecological analyses and hospital-based surveillance. A growing body of evidence also suggests acute cardiac events re potential complications of RSV, especially among older adults. Cardiac complications occur in 14% to 22% of older adults hospitalized with RSV, including heart failure exacerbation, acute coronary syndrome, and arrhythmias. However, these data rely primarily on single-center studies with small sample sizes, and research thus far has generally not examined risk factors for acute cardiac events or the severity of these events when they occur.

In their new study, investigators aimed to identify the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years and older with RSV infection. The study analyzed surveillance data from the RSV Hospitalization Surveillance Network. Investigators analyzed cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (2014-2015 through 2017-2018, and 2022-2023) in order to estimate the weighted period prevalence and 95% confidence intervals (CIs) of acute cardiac events.

The primary outcomes were severe disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events.

The analysis included 6248 hospitalized adults with laboratory-confirmed RSV infection and with a median age of 72.7 years, 59.6% female, and 56.4% with underlying cardiovascular disease. The weighted estimated prevalence of experiencing a cardiac event was 22.4%. More specifically, the weighted estimated prevalence was 15.8% for acute heart failure, 7.5% for acute ischemic heart disease, 1.3% for hypertensive crisis, 1.1% for ventricular tachycardia, and 0.6% for cardiogenic shock.

Importantly, adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event compared with those who had no underlying cardiovascular disease (33% vs 8.5%). Among all hospitalized adults with RSV, 18.6% required ICU admission and 4.9% died during their hospitalization. Compared with those without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%) and in-hospital death (8.1% vs 4%).

In 2023, the first 2 RSV vaccines were approved for use in the US in adults aged 60 years and older. Both vaccines—Arexvy from GSK and Abrysvo from Pfizer—have been proven effective in preventing symptomatic RSV lower respiratory tract disease in older adults. However, the investigators noted that clinical trials were underpowered to estimate efficacy against more severe disease.

Prevention of acute cardiac events may be another consideration for future postlicensure studies of RSV vaccines, especially among older adults with risk factors. For instance, influenza vaccination has been associated with reduced risk of acute cardiovascular risk in the hospital setting, according to the study authors.

Reference

Woodruff RC, Melgar M, Pham H, Sperling LS, et al. Acute cardiac events in hospitalized older adults with respiratory syncytial virus infection. JAMA Int Med. 2024. doi:10.1001/jamainternmed.2024.0212