Acute Cardiovascular Events Associated With Influenza in Hospitalized Adults

Details

• Alternative Title:
  Ann Intern Med
• Personal Author:
  Chow, Eric J. ; Rolfes, Melissa A. ; O’Halloran, Alissa ; Anderson, Evan J. ; Bennett, Nancy M. ; Billing, Laurie ; Chai, Shua ; Dufort, Elizabeth ; Herlihy, Rachel ; Kim, Sue ; Lynfield, Ruth ; McMullen, Chelsea ; Monroe, Maya L. ; Schaffner, William ; Spencer, Melanie ; Talbot, H. Keipp ; Thomas, Ann ; Yousey-Hindes, Kimberly ; Reed, Carrie ; Garg, Shikha
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• Description:
  Background: ; Influenza may contribute to the burden of acute cardiovascular events during annual influenza epidemics. ; Objective: ; To examine acute cardiovascular events and determine risk factors for acute heart failure (aHF) and acute ischemic heart disease (aIHD) in adults with a hospitalization associated with laboratory-confirmed influenza. ; Design: ; Cross-sectional study. ; Setting: ; U.S. Influenza Hospitalization Surveillance Network during the 2010-to-2011 through 2017-to-2018 influenza seasons. ; Participants: ; Adults hospitalized with laboratory-confirmed influenza and identified through influenza testing ordered by a practitioner. ; Measurements: ; Acute cardiovascular events were ascertained using discharge codes from the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification, and ICD, 10th Revision. Age, sex, race/ethnicity, tobacco use, chronic conditions, influenza vaccination, influenza antiviral medication, and influenza type or subtype were included as exposures in logistic regression models, and marginal adjusted risk ratios and 95% CIs were estimated to describe factors associated with aHF or aIHD. ; Results: ; Among 89 999 adults with laboratory-confirmed influenza, 80 261 had complete medical record abstractions and available ICD codes (median age, 69 years interquartile range, 54 to 81 years) and 11.7% had an acute cardiovascular event. The most common such events (non-mutually exclusive) were aHF (6.2%) and aIHD (5.7%). Older age, tobacco use, underlying cardiovascular disease, diabetes, and renal disease were significantly associated with higher risk for aHF and aIHD in adults hospitalized with laboratory-confirmed influenza. ; Limitation: ; Underdetection of cases was likely because influenza testing was based on practitioner orders. Acute cardiovascular events were identified by ICD discharge codes and may be subject to misclassification bias. ; Conclusion: ; In this population-based study of adults hospitalized with influenza, almost 12% of patients had an acute cardiovascular event. Clinicians should ensure high rates of influenza vaccination, especially in those with underlying chronic conditions, to protect against acute cardiovascular events associated with influenza. ; Primary Funding Source: ; Centers for Disease Control and Prevention.
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• Subjects:
  • Article
  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Antiviral Agents
  • Cross-Sectional Studies
  • Heart Failure
  • Hospitalization
  • Humans
  • Influenza Vaccines
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• Source:
  Ann Intern Med. 173(8):605-613
• Pubmed ID:
  32833488
• Pubmed Central ID:
  PMC8097760
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHS/United States ; U38 HM000414/HM/NCHM CDC HHS/United States ; U38 OT000143/OT/OSTLTS CDC HHS/United States
• Volume:
  173
• Issue:
  8
• Download URL:
  https://stacks.cdc.gov/view/cdc/105964/cdc_105964_DS1.pdf
• File Type:
  [PDF - 700.93 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6b4385fddce4ba34c22f56640cf4a119546da484fc226f412186e81722febe9a