Vaccine-preventable diseases in hospitalized patients with heart failure: a nationwide cohort analysis

Abstract

Abstract Introduction Infection related hospitalizations are common among patients with heart failure (HF), including those that could be prevented with appropriate vaccinations. Objective We aimed to determine the risk of vaccine preventable diseases (VPDs) in patients with HF. Methods We performed a population based retrospective cohort study using the United States- National Inpatient Sample (NIS) Database from 2010 to 2014. We identified patients who were admitted to the hospital with vaccine preventable diseases, namely influenza, varicella zoster infection (VZV), pneumococcal infection, meningococcal infection, diphtheria, pertussis, tetanus, hepatitis A (Hep A) and hepatitis B (Hep B) using international classification of diseases 9th revision clinical modification (ICD-9-CM) codes. In this cohort, we then identified patients with HF. Descriptive statistics were used to estimate the frequencies of various VPDs in patients with heart failure. A multivariate regression model adjusting for age, gender, race, immunosuppression (Diabetes, HIV, Organ transplantation, Malignancy) was employed to determine the risk of VPDs in patients with HF. Results Among a total of 11, 64,528 patients admitted with VPDs, HF was present in 1, 01,915 (8.8%).The most common VPD in patients with HF was VZV (30.7%), followed by influenza (28.2%), pneumococcal infection (20.9%) and Hep B (18.5%). Other VPDs were less common: Hep A (1.8%), diphtheria (0.4%), pertussis (0.2%), tetanus (10 patients) and meningococcal infection (0.1%). On multivariate analysis, patients with HF had increased risk of hospitalization due to influenza (aOR=1.20, 95% CI: 1.18–1.21; p<0.001) and pneumococcal infection (aOR=1.31, 95% CI: 1.29–1.33; p<0.001), but were at a lower risk of hospitalization due to VZV (aOR=0.81, 95% CI: 0.8–0.83; p<0.001), Hep B (aOR=0.78, 95% CI: 0.77- 0.8; p<0.001), Hep A (aOR=0.71, 95% CI: 0.67–0.74; p<0.001), Meningococcal infection (aOR=0.64, 95% CI: 0.52–0.78; p<0.001), diphtheria (aOR=0.79, 95% CI: 0.71–0.88; p<0.001) and tetanus (aOR=0.35, 95% CI: 0.19–0.65; p=0.001). No statistically significant association of HF was observed with pertussis (p=0.167). Conclusion In our study, patients with HF had a higher risk of hospital admissions secondary to influenza and pneumococcal infections and a lower risk of VZV, Hep B, Hep A, meningococcal infection, diphtheria, and tetanus related admissions when compared with non-HF patients. Funding Acknowledgement Type of funding source: None