Influenza and COVID-19 vaccination, departmental case-mix and cause-specific mortality in a large real-world heart failure cohort
C Bonanad Lozano, E Rodriguez Borja, A Arroyo, F Esteve Claramunt, G Zaharia, D Bompart, C Munoz-Alfonso, G Barreres Martin, D Maidana, J Galan, S Garcia-BlasAbstract
Background
Octogenarian patients with heart failure (HF) are highly vulnerable to infectious triggers such as influenza and COVID-19, which often precipitate acute decompensation and increase mortality. Despite guideline recommendations supporting systematic vaccination, real-world data regarding vaccination coverage, departmental heterogeneity, and cause-specific mortality in HF remain limited. This study examined baseline differences across hospital services, mortality patterns, and the association between vaccination and survival in a contemporary cohort of octogenarian HF patients discharged from a tertiary hospital between 2020 and July 2024.
Methods
This observational study included 7,152 HF patients aged ≥80 years who were discharged alive from a tertiary hospital during the study period and enrolled in a regional registry. Demographic characteristics, comorbidities, laboratory values, and the discharging service were collected. Vital status and cause of death were obtained from medical records and classified as cardiovascular, sudden cardiac, non-cardiovascular, infection-related, or other causes. Influenza and COVID-19 vaccination status was assessed at baseline and first follow-up. Descriptive and comparative analyses evaluated interservice heterogeneity and mortality outcomes.
Results
A total of 871 deaths occurred (12.2%). Among the 1,349 patients with documented cause-of-death data, cardiovascular mortality predominated, followed by other or unspecified causes, non-cardiovascular deaths, infection-related deaths, and sudden cardiac deaths. Although all patients were octogenarians, substantial interdepartmental variation was observed; Geriatrics and Internal Medicine managed older and more comorbid individuals than Cardiology. Vaccination data improved at follow-up. Influenza vaccination was recorded in 923 patients and COVID-19 vaccination in 888. Mortality was markedly lower in vaccinated versus unvaccinated individuals (influenza: 19.9% vs 96.0%; COVID-19: 21.4% vs 94.6%). Most patients with vaccine-dose data had received ≥3 COVID-19 doses.
Conclusions
In this large cohort of octogenarian HF patients, mortality was high and predominantly cardiovascular. Vaccination against influenza and COVID-19 was strongly associated with improved survival, supporting systematic vaccination strategies in HF care.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.