Influenza Vaccination for Secondary Prevention in CVD

Influenza-related death is more common in patients with cardiovascular disease (CVD) than in patients with any other chronic condition. However, vaccination coverage levels in this population remain well below national goals and are marked by disparities across different age and ethnic groups. To help reverse this trend, the American Heart Association (AHA) and American College of Cardiology (ACC) recommend annual influenza immunization “with the same enthusiasm as control of cholesterol, blood pressure, and other modifiable risk factors,” according to an advisory published in the October 3, 2006, issue of Circulation (available athttp://circ.ahajournals.org/cgi/content/full/114/14/1549).

Evidence from cohort studies and a randomized clinical trial indicates that annual vaccination against influenza prevents cardiovascular events and all-cause mortality in patients with cardiovascular conditions. Based on this evidence, the AHA and ACC recommend immunization with inactivated influenza vaccine (administered intramuscularly) as a component of secondary prevention for patients with coronary disease and other atherosclerotic vascular conditions. Live, attenuated vaccine (administered intranasally) is contraindicated for persons with cardiovascular conditions. Influenza vaccine should be administered to all persons with CVD unless they have a contraindication to receiving the vaccine.

One of the barriers to vaccination for patients with CVD is that cardiology practices often do not stock and administer influenza vaccine. Therefore, family physicians and other primary care physicians who treat patients with CVD can help improve inf luenza vaccination rates by providing and strongly recommending vaccination to their patients before and throughout the influenza season.