The effect of influenza vaccination on mortality and hospitalization in patients with heart failure: a systematic review and meta-analysis
Influenza infection is associated with increased risk for mortality and hospitalization in heart failure patients. Although there are no published randomized controlled trials examining the effect of influenza vaccination on clinical outcomes in heart failure patients, the effect has been examined in observational cohort studies. Nevertheless, results are inconsistent due partly to limited power with small sample sizes and use of different definitions of outcomes. We therefore aimed to conduct a systematic review and meta-analysis of the effect of influenza vaccination on mortality and hospitalization in heart failure patients. The search of electronic databases identified 6 observational cohort studies with 22,486 patients examining the effect of influenza vaccination on mortality and hospitalization in heart failure patients. Pooled analysis of confounder-adjusted hazard ratio showed that influenza vaccination was associated with reduced risk of mortality during 1-year follow-up (risk ratio [95% CI] = 0.76 [0.63–0.92], Pfix < 0.01) and during long-term (up to 4 years) follow-up (0.80 [0.71–0.90], Pfix < 0.001). Furthermore, influenza vaccination was associated with reduced risk of mortality during influenza season (risk ratio [95% CI] = 0.52 [0.39–0.69], Prandom < 0.001) and during non-influenza season (0.79 [0.69–0.90], Pfix < 0.001). Only a few studies reported the effect of influenza vaccination on hospitalization, which did not permit us to perform pooled analysis. In conclusion, our meta-analysis showed that influenza vaccination was associated with reduced risk of mortality in heart failure patients. Large-scale and adequately powered randomized controlled trials should be planned to confirm our observed potential survival benefit of influenza vaccination in these patients.
KeywordsHeart failure Influenza Vaccine Prognosis Meta-analysis
Compliance with ethical standards
Conflict of interest
Dr. Ohte has received lecture fees from Takeda Pharmaceutical Co. Ltd., Daiichi Sankyo Co., Ltd., Bayer GA, AstraZeneca plc, and Boehringer Ingelheim and grant support from Takeda Pharmaceutical Co. Ltd., Bayer GA, Daiichi Sankyo Co., Ltd., MSD, Novartis International AG, Boehringer Ingelheim, Astellas Pharma Inc., and Otsuka Pharmaceutical Co., Ltd. No other disclosures were reported.
This article does not contain any studies with human participants performed by any of the authors.
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