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Forgoing Vaccination Could Increase Mortality Risk in Heart Failure Patients

A retrospective cohort study of patients from the Mount Sinai Health System EHR suggests patients with heart failure who received a COVID-19 vaccination saw their risk of mortality decreased by more than 60% compared to unvaccinated individuals.

Patients with heart failure who forego COVID-19 vaccinations could be placing themselves into a position where their risk of mortality is 3 times greater than that of their vaccinated counterparts, according to new research from Mount Sinai Health System.

An analysis of electronic medical record data from more than 7000 patients with heart failure across the health system, results of the study, which used inverse probability treatment weight models to adjust for potential confounding, suggested patients who were vaccinated had a 64% reduction in risk of mortality compared to their unvaccinated counterparts, with even further reduction observed among those who received a booster.

“Until now, it has been difficult to explain to these patients how the cardiovascular benefits of vaccination substantially outweigh the risks of complications to them, because we didn’t have concrete evidence to show the substantial risks of being unvaccinated, as few studies have focused on this specific high-risk population and COVID-19 vaccinations,” said senior investigator Anurhada Lala, MD, director of Heart Failure Research and an associate professor of medicine at the Icahn School of Medicine at Mount Sinai, in a statement. “Having specific data showing patients with heart failure who don’t have their full vaccine series are at a much higher risk of death, intensive care unit (ICU) admission, and general hospitalization—even after accounting for factors that might be related to an individual’s decision to become vaccinated—is helpful.”

With previous reports evidencing a link between increased risk of adverse outcomes with OCIVD-19 among patients with heart failure, Lala and a team of colleagues from the Icahn School of Medicine at Mount Sinai launched the current study with the intent of assessing the impact of COVID-19 vaccine status on clinical outcomes in patients with heart failure. To do so, the investigators designed their study as a retrospective cohort study on the association of VCOVID-19 vaccinations status with hospitalizations, ICU admission, and mortality after adjustment for covariates using data from the Mount Sinai Health System electronic health record database.

From the EHR database, investigators obtained related to a cohort of 7094 heart failure patients who underwent visits from January 1, 2021-January 24, 2022. Of these, 9.1% (n=645) were partially vaccinated, 31.0% (n=2200) were fully vaccinated, 14.8% (n=1053) were vaccine-boosted, and 45.1% (n=3196) were unvaccinated. The overall cohort had a mean age of 73.3±14.5 years, 48% were women, and 63.3% had Medicare insurance. Investigators noted 77.9% had another form of cardiovascular disease, 58.3% had hypertension, and 32.0% had type 2 diabetes. Compared to their unvaccinated and partially vaccinated cohorts, those who were fully vaccinated or vaccine-boosted were older, more likely to be of White race, have Medicare insurance, and have higher rates of multiple comorbidities, including obesity, hypertension, pulmonary disease, and diabetes.

Of the 7094 patients identified for inclusion, 904 died during a mean follow-up time of 276.5±104.9 days. Of those who died during the follow-up period, 73.4% wee unvaccinated or only partially vaccinated. In adjusted analyses, those in the vaccine-boosted cohort had the lowest mortality risk (HR, 0.33 [95% CI, 0.23-0.48]) compared to unvaccinated individuals, followed by full vaccinated patients (HR, 0.36 [95% CI, 0.30-0.43]) (P <.001). Investigators pointed out there was no significant difference in mortality risk observed among partially vaccinated patients compared to unvaccinated patients (HR, 0.87 [95% CI, 0.68-1.12]; P=.28). Further analysis indicated fully vaccinated or boosted patients were significantly less likely to be admitted to the hospital (IRR, 0.68 [95% CI, 0.65-0.71]; P <.001) or admitted to the ICU (IRR, 0.63 [95% CI, 0.58-0.68]) than their unvaccinated or partially vaccinated counterparts.

“The findings further emphasize that heart failure patients need to take vaccines seriously, since they have worse outcomes if infected with COVID-19, and stresses the importance of receiving the full COVID-19 vaccination dosage, especially since our previous work shows those with heart failure are 2.5 times more likely to die from the virus,” Lala added. “I have used these results to help educate reluctant patients and, in many cases, this has been effective in encouraging them and getting them to follow through with full vaccination. The hope is that cardiologists will use these results as a tool to help their patients and improve their chances of survival.”

This study, “Association of Reduced Hospitalizations and Mortality Among COVID-19 Vaccinated Patients with Heart Failure,” was published in the Journal of Cardiac Failure.