Receipt of respiratory vaccines among patients with heart failure in a multicenter health system registry

Background: Heart failure affects people of all ages and is a leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are common causes of hospitalizations in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide significant protection against preventable respiratory infections. Despite being an easily accessible intervention, prior studies suggest vaccines are underused in patients with heart failure. Methods: An observational study of 5089 adults with heart failure was conducted using data from an integrated, multicenter, academic health system in Southern California from 2019 to 2022. Logistic regression models were used to determine the rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure preserved ejection fraction [HFpEF], heart failure mildly reduced ejection fraction [HFmrEF], and heart failure reduced ejection fraction [HFrEF], and identify whether heart failure phenotype is associated with vaccination status. Results: Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 58.0 % of patients had received an influenza vaccine, 76.2 % had received a pneumococcal vaccine, and 83.3 % had received a COVID-19 vaccine. There were no sex-based differences by vaccination status. Differences were seen within age, race/ethnicity, insurance type, whether the patient was a member of an Accountable Care Organization (ACO), primary language, Social Vulnerability Index (SVI) score, clinician type, and number of comorbidities. Patients with HFpEF and HFmrEF had higher vaccination rates than HFrEF. In adjusted models, patients with HFrEF had lower odds of being vaccinated for influenza (aOR = 0.75, 95 % CI = 0.66-0.86), pneumococcal (aOR = 0.65, 95 % CI = 0.55-0.75), and COVID (aOR = 0.74, 95 % CI = 0.62-0.89) compared to patients with HFpEF. Conclusions: Patients with HFrEF had the lowest levels of respiratory vaccination compared to other specified heart failure categories. Interventions are needed to increase vaccination education and offerings, especially to patients with HFrEF.