Respiratory Viral Infections Increase Risk of Heart Failure: Implications for Prevention

Overview

Hospitalization for respiratory viral infections (RVIs) such as RSV, influenza, and COVID-19 significantly raises the risk of new-onset heart failure (HF) and HF exacerbations. Vaccination against these viruses demonstrates a protective cardiovascular effect, highlighting the importance of immunization in at-risk populations.

Background

Respiratory viral infections have acute respiratory effects and can trigger cardiovascular complications including heart failure. A large retrospective cohort study from Singapore analyzed over 59,000 patients without prior HF and more than 4,000 with established HF, comparing them to matched orthopedic controls. The study quantified the medium-term risk of HF following hospitalization for RVIs, emphasizing the intersection between infectious diseases and cardiovascular outcomes in the post-COVID-19 era.

Data Highlights

Key Findings

• Hospitalization for RVIs is associated with a 45% increased risk of new-onset heart failure in patients without prior HF.
• Patients with established HF have a 28% higher risk of HF readmission following RVI hospitalization.
• RSV infection confers the highest risk of new-onset HF compared to influenza and COVID-19.
• Vaccination against influenza and COVID-19 reduces the risk of HF events post-infection, with recent vaccination or multiple doses linked to no increased HF risk.
• RSV vaccination in older adults reduces cardiorespiratory hospitalizations and HF admissions, supporting its role in cardiovascular prevention.
• Despite benefits, vaccine uptake among HF patients remains suboptimal, representing a missed opportunity for prevention.

Clinical Implications

Clinicians should incorporate cardiovascular risk assessments for patients aged 65 and older following RVI hospitalization. Vaccination against influenza, COVID-19, pneumococcus, and RSV should be prioritized as a cardiovascular preventive strategy, not solely for infection prevention. Integrating vaccination programs within chronic disease management pathways may improve uptake and reduce HF burden.

Conclusion

Respiratory viral infections significantly increase the risk of heart failure, but vaccination offers a powerful protective effect. Prioritizing immunization in at-risk populations can reduce cardiovascular morbidity and healthcare burden.

References

1. Wee et al. 2024 -- Risk of new-onset heart failure and heart failure exacerbations following COVID-19, influenza or respiratory-syncytial-virus hospitalisation
2. Canadian cohort study -- RSV hospitalization linked to higher HF events
3. Rochester NY retrospective study -- RSV hospitalization and acute CV events
4. FluHeart study -- Left ventricular dysfunction in influenza patients
5. PANDA-2 trial -- Influenza vaccination reduces mortality and rehospitalization in acute HF
6. DAN-RSV trial -- RSV vaccination reduces cardiorespiratory and HF hospitalizations
7. French cohort study -- Low influenza vaccine uptake in HF patients