The American Heart Association and the American College of Cardiology are asking heart doctors to do something they may not normally do — give flu shots to their patients. However, patients with cardiovascular disease should not get the nasal-spray flu vaccine.
Patients with cardiovascular disease are more likely to die from influenza than patients with any other chronic condition, according to the new AHA/ACC scientific advisory.
Studies have found that annual flu vaccinations can prevent death in adults and children with chronic conditions of the cardiovascular system. But only one in three adults with cardiovascular disease was vaccinated against flu in 2005.
Overall, influenza is responsible for 36,000 deaths and 225,000 hospitalizations in the United States each year. People with cardiovascular disease are particularly vulnerable, because the flu can exacerbate heart disease symptoms directly, and can also lead to conditions like viral or bacterial pneumonia that cause flare-ups of cardiovascular disease, he said.
Immunization against seasonal influenza has a critical, but underappreciated, role in preventing death among cardiovascular disease patients.
The strongest evidence of a protective effect comes from the FLUVACS trial. In that trial, among those who did not get vaccinated 23 percent had died of heart disease, had a nonfatal heart attack or developed severe ischemia (insufficient blood supply to the heart tissue) over the next year, compared with only 11 percent of their vaccinated counterparts.
The advisory urges that patients with cardiovascular disease get a flu vaccination (given by injection) every year by the end of November. Receiving a shot in January or even later should still protect from flu, as the flu season in the United States typically peaks in January, February or March.
Patients with cardiovascular disease should not receive the live, attenuated vaccine given as a nasal spray. The live vaccine can cause influenza in this high-risk population.
The advisory is consistent with the recommendations of the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices.
The advisory is available online at www.americanheart.org and www.acc.org; and will be published in Circulation: Journal of the American Heart Association and Journal of the American College of Cardiology.