United States: Around 22% of hospitalized individuals aged 50 years or more with respiratory syncytial virus (RSV) infection encountered an acute cardiac incident, predominantly acute heart failure (16%), according to a recent published by JAMA Medicines. Furthermore, 1 in 12 infected patients (8.5%) manifested no documented underlying cardiovascular diseases.
RSV is linked with annual figures of up to 160,000 hospitalizations in the United States, resulting in 10,000 fatalities and USD 4 billion in direct healthcare expenses among adults aged 65 years or above.
“The historical underestimation of RSV infection severity in adults by public health experts and clinicians is evident despite substantial evidence of RSV-associated morbidity, mortality, and healthcare spending,” the authors remarked. RSV is seldom screened for in clinical settings, with symptoms often resembling those of other respiratory ailments, they note.
The study encompassed outcomes among 6,248 adults aged 50 years and older hospitalized for RSV between 2014 and 2018, as well as in 2022 and 2023, across 12 states in the US. Nearly 60 percent of the adults were females, and 65.9% were of Caucasian ethnicity.
Upon admission to the hospital, 93.1% of the participants exhibited fever, and 80.6 percent presented with a cough.
Prevalence of Heart Failure
The majority of the patients (56.4%) were patients who had some sort of preexisting cardiovascular conditions such as heart failure (31.9%), coronary artery disease (30.2%), and atrial fibrillation (25.2%). After cardiac disease, which accounted for 35 percent of reported cases, diabetes and COPD were the two most widely mentioned as the underlying conditions qualified of 34.8% (percentage for diabetes) and 34.8 (percentage for COPD).
The weighted prevalence of occurring acute cardiac events was 22.4% (95% Confidence Interval [CI]: 21.0% to 23.7%) for hospitalized adults aged 50 years or older with RSV (respiratory syncytial virus) infection, according to the researchers, from whom the most prevalent event of the cardiac diseases was acute heart failure, across all RSV-infected individuals.
With the presence of preexisting cardiovascular diseases, patients had a higher percentage of unstable cardiac events of any type than patients without the mentioned conditions (33.0% vs. 8.5%). For them as well, the risk of experiencing an unstable cardiac event was also higher if they were 85 years old or older and had a history of heart attack and arrhythmia.
Not only this, but hospital-acquired MI/NSTEMI during hospitalization was closely related to more severe RSV outcomes (ICU admission, severe mechanical ventilation requirement, and in-hospital death).
According to the study, the risk of heart attack, both acute and chronic heart failure, was high among adults with a history of preexisting cardiac conditions; chronic heart failure was not exempted. Thus, coronary events have been shown equally between unhealthy participants and those with at least one other disease. It was found that in 12 adults without prior diagnosis of cardiovascular disease, acute cardiovascular events were seen, reaffirming the high association of RSV infection with the occurrence of severe cardiac events.
Low Uptake of RSV Vaccine
Awareness regarding the substantial impact of RSV in the United States is increasing, and in 2023, the first vaccine for individuals aged 65 and older was approved for use among older adults.
In an editorial note accompanying the study, Tracy Wang, MD, MHS, an associate editor of JAMA Internal Medicine, cautions that RSV vaccine adoption among older adults has been notably low, considerably lower than that of influenza vaccination.
“Previous RSV-related initiatives have primarily targeted infants and young children, with many clinicians and patients still uninformed about the burden of RSV disease and prognosis in older adults,” Wang notes. Moreover, insurance coverage for RSV vaccines is inconsistent.
“This disparity in coverage necessitates many clinics to refer patients to pharmacies for vaccination, and out-of-pocket expenses may be required,” she added. “Efforts to address vaccine fatigue and access barriers among eligible individuals are imperative to enhance adoption among those who stand to benefit.”