Nearly 25% of hospitalised, RSV-infected patients experienced acute adverse cardiac events.

We know that severe influenza in older adults can precipitate adverse cardiovascular (CV) events (NEJM JW Gen Med Nov 1 2020 and Ann Intern Med 2020; 173: 605-613). To find out if this also is true for respiratory syncytial virus (RSV) infection, researchers performed a cross-sectional study of 6000 hospitalised adults (age, 50 years or older) who tested positive for RSV in 12 US states during five RSV seasons. Mean age was 73 years, and 56% had known cardiovascular disease.

Overall, 23% of the 6000 patients experienced adverse CV events, most commonly acute heart failure or myocardial injury. These events occurred in 33% of patients with known CV disease but also in 9% of patients without known CV disease. Compared with patients who did not have acute adverse CV events, those with adverse CV events had about 50% higher risk for intensive care unit admission and doubled risk for in-hospital death.

Comment: This study suggests that older patients hospitalised with acute RSV infections are at substantial risk for adverse CV events, with associated morbidity and mortality. The findings are relevant because RSV vaccines recently were approved for people who are 60 years or older, based on their effectiveness in preventing lower respiratory tract disease (NEJM JW Infect Dis May 17 2023; [e-pub] and N Engl J Med 2023; 388: 1465-1477). The vaccine trials were underpowered to estimate effectiveness in preventing severe disease, but the results of the current study imply an opportunity to lower the burden of RSV hospitalisation and complications through vaccination. The results also provide information for patients to consider during ‘shared decision making’ regarding the RSV vaccine.

Aaron J. Calderon, MD, FACP, SFHM, Program Director, Internal Medicine Residency, Saint Joseph Hospital; Clinical Professor of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Denver, USA.

Woodruff RC, et al. Acute cardiac events in hospitalized older adults with respiratory syncytial virus infection. JAMA Intern Med 2024 Apr 15; e-pub (https://doi.org/10.1001/ jamainternmed.2024.0212).

This summary is taken from the following Journal Watch titles: General Medicine, Hospital Medicine.