Flu vaccine uptake in patients with CVD decreases with younger age
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Influenza vaccination rates were low in younger patients with CVD despite having the opportunity to be vaccinated at no cost, researchers reported in the European Heart Journal – Quality of Care & Clinical Outcomes.
“We were surprised by the low uptake of influenza vaccination among younger patients,” Daniel Mølager Christensen, MD, PhD fellow from the Danish Heart Foundation in Copenhagen, Denmark, told Healio. “The vaccine is recommended and provided free in Denmark to any individual older than 65 years and to patients of any age with a chronic disease, such as heart disease.”
In a nationwide registry-based study in Denmark, Christensen and colleagues evaluated an average of 397,346 patients with prevalent CVD during each of the 2017, 2018 and 2019 influenza seasons, which occur annually from October to December, to observe rates of vaccination.
Patient data were obtained from six registries: the Civil Registration System, the National Patient Registry, the National Prescription Registry, the Cause of Death Registry, the Danish Education Registries and the Danish National Health Service Registry.
The researchers defined prevalent CVD as HF, atrial fibrillation, ischemic heart disease (IHD) or stroke that occurred in the 10 years before the inclusion dates.
The main outcome was the relative frequency of influenza vaccination during the three influenza seasons.
Researchers found that from the yearly average number of patients with CVD, 15.6% had HF, 36.7% had AF, 47.6% had IHD, 29.8% had a stroke, 24.1% had two or more related CVDs and 29.9% had a minimum of one additional comorbidity such as diabetes, chronic kidney disease, chronic respiratory disease, chronic liver disease or severe mental illness.
For the entire population, vaccine uptake was 45.6%. In patients aged at least 65 years, percentages ranged from 55% in stroke to 61.8% in HF. However, Christensen and colleagues observed that vaccine uptake was lower as patients got younger. Uptake was 32.6% in HF, 19% in AF, 21.1% in IHD and 18.3% in stroke for patients younger than 65 years.
The percentage of patients with CVD who received an influenza vaccine was even lower in those younger than 54 years. Among men aged 45 to 54 years, 25.5% with HF, 11.5% with AF, 13.8% with IHD and 12.1% with stroke received the vaccine, and in men younger than 45 years, uptake was 21.6% in HF, 5.5% in AF, 7.4% in IHD and 6.3% in stroke.
Lower uptake percentages were also found in those who did not receive a vaccine in the previous influenza season (eg, 25.4% vs. 86.3% in women aged 65 to 74 years with HF).
Additionally, civil status and level of education contributed to variation in vaccine uptake, according to the researchers.
“It seems like age may be the most important consideration when clinicians and patients decide whether to vaccinate against seasonal flu,” Christensen told Healio. “We would like to urge clinicians to consider if patients are ‘at risk’ due to, for example, heart disease, even if they are young.
“Perhaps future studies need to investigate the effectiveness of seasonal flu vaccination, specifically in the young,” he added. “If there was even stronger evidence for the benefit, more patients and clinicians would perhaps be convinced to vaccinate.”
For more information:
Daniel Mølager Christensen, MD, can be reached at dmchristensen@hjerteforeningen.dk.
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Christensen DM, et al. Eur Heart J Qual Care Clin Outcomes. 2022:doi:10.1093/ehjqcco/qcac049.
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