COVID-19 Vaccination Tied to Better Outcomes in HF Patients

Patients with heart failure who are fully vaccinated and/or boosted against COVID-19 have lower risks of hospitalization, ICU admission, and death compared with their unvaccinated or only partially vaccinated peers, data from a large New York City health system indicate.

The retrospective study, published as a brief report in the Journal of Cardiac Failure, suggests that patients with heart failure should not fear getting a COVID-19 vaccine.

Senior author Anuradha Lala, MD (Icahn School of Medicine at Mount Sinai, New York, NY), told TCTMD the study was inspired by her interactions with wary heart failure patients during the pandemic. “I was struck by the number of patients who expressed a hesitancy to getting the vaccine mainly because they were afraid of any kind of adverse cardiac effects the vaccine may have,” she said.

Prior research from her group and others has shown heart failure to be associated with worse COVID-19 outcomes. Moreover, patients with heart failure have been included in studies demonstrating the benefits of vaccination against the disease. But an analysis addressing the potential impact of vaccination specifically in patients with heart failure has been missing.

In that context, this study provides “observational data to show directly that COVID-19 vaccination was associated with a significant reduction not only in hospitalizations, but mortality,” Lala said. “So it just lends further evidence to support the importance of its implementation in this high-risk cohort.”

For the study, with lead authors Kipp Johnson, MD, PhD, and Sonika Patel, MD (Icahn School of Medicine at Mount Sinai), the investigators examined electronic health record data on 7,094 patients (mean age 73.3 years; 48% women) with heart failure and elevated natriuretic peptide levels treated within their health system. As of January 2022, 9.1% were partially vaccinated against COVID-19, 31.0% were fully vaccinated, 14.8% were fully vaccinated and boosted, and 45.1% were unvaccinated.

Over a mean follow-up of 276.5 days, a lower risk of mortality was observed in patients who were boosted (HR 0.33; 95% CI 0.23-0.48) and who were fully vaccinated (HR 0.36; 95% CI 0.30-0.43) compared with those who remained unvaccinated in inverse probability treatment weighted models. Mortality risk didn’t differ between the unvaccinated and those who were only partially protected.

When you’re able to show those graphs with the improved survival or decreased mortality, I think it’s very convincing to patients. Anuradha Lala

Patients who were fully vaccinated and/or boosted also were less likely to be hospitalized (incidence rate ratio 0.68; 95% CI 0.65-0.71) or to be admitted to the ICU (incidence rate ratio 0.63; 95% CI 0.58-0.68) compared with the other groups.

Similar results were seen in an analysis restricted to patients who tested positive for SARS-CoV-2.

Lala said the findings of the study confirmed her suspicions, although the magnitude of the associations were unexpected. “Of course, these are observational data, so you have to take it with a grain of salt,” she added.

Despite the fact that this analysis didn’t capture potential adverse effects of the shots themselves, it should be enough to overcome some of the fears of vaccination—such as potential cardiac effects—patients have, Lala said.

“I already was convinced” that COVID-19 vaccination is beneficial in patients with heart failure, she said. “But now I’m extra convinced. . . . When you’re able to show those graphs with the improved survival or decreased mortality, I think it’s very convincing to patients. More than convincing, I think it’s reassuring.”

And that’s important given that the pandemic is ongoing, Lala indicated. “We still need to remain vigilant in educating our patients and partnering with them and ensuring that we earn their trust to make sure that they’re getting the protection that they need.”

Professional societies support vaccination in patients with various types of cardiovascular disease. The American Heart Association, for instance, says “people with cardiovascular risk factors, heart disease, and heart attack and stroke survivors should get vaccinated as soon as possible because they are at much greater risk from the virus than they are from the vaccine.” And in October 2021, the Heart Failure Association of the European Society of Cardiology stated that “COVID-19 vaccination is indicated for all patients with heart failure unless other contraindications exist.”