• Matthew T Mefford, Ran Liu, Katia Bruxvoort, Lei Qian, Jonathan M Doris, Sandra Y Koyama, Hung Fu Tseng, and Kristi Reynolds.
• Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. matthew.t.mefford@kp.org.
• J Gen Intern Med. 2022 Aug 1; 37 (10): 240524122405-2412.

BackgroundInfluenza infection can result in decompensation or exacerbation of heart failure (HF) symptoms, hospitalization, and death.ObjectiveTo examine the association of influenza vaccination with mortality and hospitalization during influenza and non-influenza seasons between 2009 and 2018.Design, Setting, And ParticipantsIn this prospective, observational cohort study, we included Kaiser Permanente Southern California members with a HF diagnosis prior to September 1 each year from 2009 to 2017.ExposureThe first influenza vaccination in each season (September 1 to May 31) was recorded. Vaccinated/unvaccinated patients were matched 1:1 on age, sex, and ejection fraction at the vaccination date (n-total = 74,870).Main OutcomesPatients were followed through the end of each influenza season for all-cause mortality. Secondary outcomes included cardiovascular mortality and all-cause hospitalization. In a sensitivity analysis, we examined mortality in the non-influenza season.ResultsInfluenza vaccinated vs unvaccinated patients had more comorbidities and higher healthcare utilization. After multivariable adjustment for utilization, sociodemographics, comorbidities, and medications, influenza vaccinated vs unvaccinated patients had a lower risk of all-cause mortality and cardiovascular mortality during the influenza season (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.63, 0.70 and HR 0.68, 95% CI 0.63, 0.74, respectively) but a higher risk of all-cause hospitalization (HR 1.27, 95% CI 1.21, 1.31). There was no association between influenza vaccination and all-cause or cardiovascular mortality during the non-influenza season (HR 0.99, 95% CI 0.89, 1.09 and HR 1.00, 95% CI 0.84, 1.21, respectively).ConclusionsInfluenza vaccination in HF patients was associated with a lower risk of mortality during the influenza season. Our findings provide support for recommendations of universal influenza vaccination in patients with HF.© 2021. Society of General Internal Medicine.

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