United States: RSV, which is known as Respiratory Syncytial Virus, is considered to be a threat for the majority of Americans; however, it is also known that respiratory infection is still a matter of concern as it is responsible for acute cardiac events.
A recent investigation published in JAMA Internal Medicine reveals that 22 percent of elderly patients aged 50 and above admitted to hospitals with respiratory syncytial virus (RSV) infection encountered an acute cardiac episode, predominantly acute heart failure (16 percent). Furthermore, 8.5 percent of afflicted individuals displayed no documented pre-existing cardiovascular conditions.
RSV is linked with an annual tally of up to 160,000 hospitalizations in the United States, leading to 10,000 fatalities and incurring direct healthcare expenses amounting to USD 4 billion among adults aged 65 years and older.
The authors remark, “Despite evident morbidity, mortality, and healthcare spending associated with RSV, its potential severity in adults has historically been undervalued by public health authorities and clinicians.” They note that RSV is seldom screened for in clinical settings, with symptoms often mimicking those of other respiratory ailments.
The study scrutinized outcomes among 6,248 individuals aged 50 and over who were hospitalized for RSV between 2014 and 2018, as well as in 2022 and 2023, across 12 US states. Nearly 60 percent of the participants were female, and 65.9 percent were Caucasian.
Upon admission, 93.1 percent of the subjects exhibited fever, while 80.6 percent presented with coughing.
Heart failure emerges as the most prevalent complication
Of the patients, 56.4% had underlying cardiovascular issues, encompassing 31.9% with heart failure, 30.2% with coronary artery disease, and 25.2% with atrial fibrillation. Following cardiovascular ailments, diabetes (35%) and chronic obstructive pulmonary disease (34.8%) were the most frequent underlying conditions.
According to the authors, figuring out the exact rate of acute cardiac incidents, such as heart attacks, among hospitalized adults aged 50 and above who also have already been diagnosed with RSV infection, the statistic is 22.4% (95% confidence interval [CI] 21.0% to 23.7%). Seventeen percent of RSV-infected patients experienced acute heart failure (95% CI, 16.4% to 19.2%) as the main event for the overall RSV patient population.
The people who had pre-existed with cardiovascular conditions had bigger stuff to be worried about as opposed to the conditions of people who did not have those conditions in case they experienced any cardiac event that can happen instantly(33.0% vs. 8.5%). In the past, heart failure, a person aged 85+, and arrhythmia or atrial fibrillation would be the main contributors to an increase in acute cardiac events.
Patients who had an acute life-threatening condition during their hospitalization for RSV seem to have complicated outcomes with the need for admission into the intensive care unit, mechanical ventilation, and in-hospital death.
In their conclusion, the authors stated, “Past heart diseases were frequent in adults with a history of cardiovascular disease, mainly chronic heart failure. Nonetheless, acute heart-related episodes also occurred in about 1 in 12 adults without a medical record on the condition, implying that a severe RSV infection could be the cause or discovery of cardiovascular diseases that were previously not diagnosed.”
Low uptake of RSV vaccine
Awareness of RSV’s substantial impact in the US is expanding. In 2023, the first vaccine for individuals aged 65 and older was sanctioned for use in this demographic.
In an editorial note accompanying the study, Tracy Wang, MD, MHS, an associate editor at JAMA Internal Medicine, cautions that RSV vaccine uptake among older Americans remains remarkably low, far lower than influenza vaccination rates.
“Previous efforts targeting RSV have concentrated on infants and young children, leaving many healthcare providers and patients unaware of the disease burden and prognosis of RSV in older adults,” Wang notes. Furthermore, insurance providers do not cover RSV vaccines consistently.
“This disparity in coverage necessitates many clinics to refer patients to pharmacies for vaccination, potentially incurring out-of-pocket expenses,” she adds. “Addressing vaccine fatigue and access barriers among eligible individuals is imperative to enhance uptake among those who could benefit.”