The assumption has been that infection from the RSV usually is milder than other seasonal respiratory infections. A surprising new study reveals, however, that 14.5% of hospitalized adults aged 50 years or older with RSV infection experienced acute heart failure, which was a higher prevalence than with influenza or COVID-19 infection. The solution, according to public health officials, is for older adults to receive an effective vaccine against RSV.

Immunization levels against RSV among adults aged 60 years and older remained relatively low (around 24%) as of late April compared with an influenza vaccine rate in adults aged 65 years and older of about 70%, according to the CDC.

Yet, evidence is growing that RSV can be as dangerous in many ways as influenza and COVID-19—or even more so—in some situations for older adults. The latest study pointed out that while it is well understood that RSV can cause severe respiratory illness in older adults, not as much is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection.

The researchers sought to describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection. Their results appeared in the Journal of the American Medical Association Internal Medicine.

The cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected during clinician-directed laboratory testing. The team examined cases of RSV infection in adults aged 50 years or older in 12 states over five RSV seasons—annually from 2014–2015, 2017–2018, and 2022–2023—to estimate the weighted period prevalence and 95% CIs of acute cardiac events.

The focus was on acute cardiac events, as well as severe disease outcomes, including ICU admission, receipt of invasive mechanical ventilation, or in-hospital death. The authors calculated adjusted risk ratios (ARRs) to compare severe outcomes among patients with and without acute cardiac events.

The study included 6,248 hospitalized adults (median [interquartile range] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection.

The results indicated that the weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure; 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease; 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis; 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia; and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock.

“Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs. 8.5%; ARR, 3.51; 95% CI, 2.85-4.32),” the researchers advised. “Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs. 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs. 4.0%; ARR, 1.77; 95% CI, 1.36-2.31).”

The study team emphasized that over five RSV seasons, “nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.”

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