Author + information
- Received March 11, 2018
- Revision received April 4, 2018
- Accepted April 4, 2018
- Published online September 24, 2018.
- Ankeet S. Bhatt, MD, MBAa,
- Li Liang, PhDb,
- Adam D. DeVore, MD, MHSa,b,
- Gregg C. Fonarow, MDc,
- Scott D. Solomon, MDd,
- Orly Vardeny, PharmD, MSe,
- Clyde W. Yancy, MDf,
- Robert J. Mentz, MDa,b,
- Yevgeniy Khariton, MDg,
- Paul S. Chan, MD, MScg,
- Roland Matsouaka, PhDb,
- Barbara L. Lytle, MSb,
- Ileana L. Piña, MD, MPHh and
- Adrian F. Hernandez, MD, MHSa,b,∗ ()
- aDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- cAhmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California
- dDivision of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- eUniversity of Wisconsin, School of Pharmacy, Madison, Wisconsin
- fDivision of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- gDepartment of Cardiovascular Outcomes Research, University of Missouri-Kansas City, St. Luke’s Mid-America Heart Institute, Kansas City, Missouri
- hDivision of Cardiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- ↵∗Address for correspondence:
Dr. Adrian F. Hernandez, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715.
Objectives This study sought to evaluate and contribute to the limited data on U.S. hospital practice patterns with respect to respiratory vaccination in patients hospitalized with heart failure (HF).
Background Respiratory infection is a major driver of morbidity in patients with HF, and many influenza and pneumococcal infections may be prevented by vaccination.
Methods This study evaluated patients hospitalized at centers participating in the Get With The Guidelines–HF (GWTG-HF) registry from October 2012 to March 2017. The proportion of patients receiving vaccination was described for influenza and pneumococcal vaccination, respectively. The association of hospital-level vaccination rates with individual GWTG-HF performance measures and defect-free care was evaluated using multivariable modeling.
Results This study evaluated 313,761 patients discharged from 392 hospitals during the study period. The proportion of patients receiving influenza vaccination was 68% overall and declined from 70% in 2012 to 2013 to 66% in 2016 to 2017 (p < 0.001), although this was not statistically significant after adjustment (odds ratio: 1.05 per flu season; 95% confidence interval [CI]: 0.94 to 1.18). The proportion of patients receiving pneumococcal vaccination was 66% overall and decreased over the study period from 71% in 2013 to 60% in 2016 (p < 0.001), remaining significant after adjustment (odds ratio: 0.75 per calendar year; 95% CI: 0.67 to 0.84). Hospitals with higher vaccination rates were more likely to discharge patients with higher performance on defect-free care and individual GWTG-HF performance measures (p < 0.001). In a subset of patients with linked Medicare claims, vaccinated patients had similar rates of 1-year all-cause mortality (adjusted hazard ratio: 0.96 [95% CI: 0.89 to 1.03] for influenza vaccination; adjusted hazard ratio: 0.95 [95% CI: 0.89 to 1.01] for pneumococcal vaccination) compared with those not vaccinated.
Conclusions Nearly 1 in 3 patients hospitalized with HF at participating hospitals were not vaccinated for influenza or pneumococcal pneumonia, and vaccination rates did not improve from 2012 to 2017. Hospitals that exhibited higher vaccination rates performed well with respect to other HF quality of care measures. Vaccination status was not associated with differences in clinical outcomes. Further randomized controlled data are needed to assess the relationship between vaccination and outcomes.
The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. This project was supported by the GWTG-HF program. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. DeVore has received research support from the American Heart Association, Amgen, the National Heart, Lung, and Blood Institute, and Novartis; and consulting fees from Novartis. Dr. Fonarow has received research support from the National Institutes of Health and consulting fees from Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical; and has served on the GWTG Steering Committee. Dr. Solomon has received research support from Novartis and Sanofi Pasteur. Dr. Mentz has received research support from the National Institutes of Health (grants U10HL110312 and R01AG045551-01A1), Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Merck, Novartis, Otsuka, and ResMed; and honoraria from HeartWare, Janssen, Luitpold Pharmaceuticals, Novartis, ResMed, and Thoratec/St. Jude. Dr. Khariton is supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, under award number T32HL110837. Dr. Hernandez has received research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, Sanofi, and Novartis; and honoraria from Bayer, Boston Scientific, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 11, 2018.
- Revision received April 4, 2018.
- Accepted April 4, 2018.