Heart failure

COVID-19 vaccine is safe in patients with heart failure

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Patients with heart failure (HF) who received two doses of COVID mRNA vaccines were no more likely to have disease worsening, venous thromboembolism, or myocarditis within 90 days than similar patients not vaccinated, in a case-control study in Denmark.

Additionally, within 90 days of receiving the second vaccine, vaccinated patients were less likely to die from any cause compared to unvaccinated patients during a similar 90-day period.

Caroline Sindet-Pedersen, PhD, Herlev and Gentofte Hospital, Hellerup, Denmark, and colleagues presented these results on August 26 at the 2022 European Society of Cardiology (ESC) Annual Meeting.

The major risk is not receiving a vaccine

These results “confirm that the major risk for patients with HF is not being vaccinated against COVID-19,” said Marco Metra, MD, who was not involved in this research. lecoeur.org | Medscape Cardiology.

Metra was co-author of a ESC Guidance for the Diagnosis and Management of Cardiovascular Disease During the COVID-19 Pandemic, published online ahead of print November 2021 in the European journal of the heart.

The guidelines explain that patients with HF are at increased risk of hospitalization, need for mechanical ventilation and death from COVID-19, and that vaccination reduces the risk of serious illness from COVID-19, explain Sindet-Pedersen and his colleagues in a press. ESC release.

However, “concerns remain,” they add, “about the safety of SARS-CoV-2 mRNA vaccines in patients with heart failure, due to a perceived increased risk of cardiovascular side effects.”

The results of the study suggest that “there should be no concern about cardiovascular side effects of mRNA vaccines in patients with heart failure,” summarize Sindet-Pedersen and colleagues.

The results also “indicate a beneficial effect of vaccination on mortality” and “indicate that patients with HF should be prioritized for COVID-19 vaccinations and boosters,” they add.

“There are ongoing concerns about the safety of COVID-19 vaccination in frail patients and patients with heart failure (HF),” said Metra, professor of cardiology and director of the Heart Institute. from the Civil Hospital and University of Brescia, Italy.

“These concerns are not based on evidence but only on reports of rare side effects (namely, myocarditis and pericarditis) in vaccinated people,” he added.

Metra also co-wrote a stand on COVID-19 vaccination in patients with heart failure from the Heart Failure Association of the ESC, which was published online in October 2021 in the European Journal of Heart Failure

“The current study,” he summarized, “shows a lower mortality risk in vaccinated patients compared to unvaccinated ones.”

“It has limitations,” he cautioned, “because this is not a randomized prospective study, but [rather] an observational with comparison between vaccinated and unvaccinated patients with similar characteristics.”

“However, this was done in a large population,” he noted, “and its results confirm that the major risk for HF patients is not being vaccinated against COVID-19.” .

95% of IC patients in Denmark undergo double vaxx

The group did not analyze the types of death from all causes in their study, Sindet-Pedersen said in an email to lecoeur.org | Medscape Cardiology.

Other studies have shown that vaccines are associated with better survival, she noted. For example, Bacille Calmette-Guérin vaccines and measles vaccines have been associated with a decreased risk of nonspecific mortality in children, and influenza vaccines are associated with a decreased all-cause mortality confounded in patients with HF.

Vaccination rates in this study were much higher than those of HF patients in the United States.

As mentioned earlier, in a study of 7,094 patients with HF seen at Mount Sinai Health System between January 2021 and January 2022, 31% of patients were fully vaccinated with two doses and 14.8% also received a booster, according to Centers for Disease Control and Prevention. However, an additional 9.1% of patients were only partially vaccinated with one dose and 45% were still unvaccinated in January 2022.

In the current study, “uptake was very high,” Sindet-Pedersen noted, meaning “95% of patients with prevalent heart failure in 2021 received a vaccine.”

“It may be that the last 5% of patients who did not receive a vaccine were too sick (terminally ill) to receive the vaccine,” she speculated, “or it was due to personal reasons” .

The researchers identified 50,893 patients with IC who underwent double vaxxing in 2021 and they matched them with 50,893 unvaccinated patients with IC in 2019 (prepandemic), with the same age, sex , duration of CI, use of medications for CI, ischemic heart disease, cancer, diabetes, atrial fibrillation and admission with CI within 90 days.

Almost all patients in the vaccinated group received the Pfizer/BioNTech mRNA vaccine (92%) and the remainder received the Moderna mRNA vaccine (8%), in 2021.

The patients had an average age of 74 years and 64% were men. They had CI for a median of 4.1 years.

During the 90-day follow-up, 1311 patients in the unvaccinated cohort (2.56%) and 1113 patients in the vaccinated cohort (2.23%) died; there was a significantly lower risk of death from any cause in the vaccinated cohort compared to the unvaccinated cohort (–0.33 percentage points; 95% CI, –0.52 to –0.15 percentage points ).

The risk of worsening heart failure was 1.1% in each group; myocarditis and venous thromboembolism were extremely rare, and the risks for these conditions were not significantly different in the two groups.

The researchers and Metra say they have no relevant financial information. Metra is editor-in-chief of European Journal of Heart Failure and consultant editor of European journal of the heart.

European Society of Cardiology (ESC) Congress 2022. Presented August 26, 2022.

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