Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study

Daniel Modin; Mads Emil Jørgensen; Gunnar Gislason; Jan Skov Jensen; Lars Køber; Brian Claggett; Sheila M. Hegde; Scott D. Solomon; Christian Torp-Pedersen; Tor Biering-Sørensen

doi:10.1161/CIRCULATIONAHA.118.036788

Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study

Daniel Modin^*, Mads Emil Jørgensen, Gunnar Gislason, Jan Skov Jensen, Lars Køber, Brian Claggett, Sheila M. Hegde, Scott D. Solomon, Christian Torp-Pedersen, Tor Biering-Sørensen

^*Corresponding author for this work

Department of Clinical Medicine

36 Citations (Scopus)

Abstract

Background: Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF. Methods: We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134 048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression. Results: Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7-6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination. Conclusions: In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination.

Original language	English
Journal	Circulation
Volume	139
Issue number	5
Pages (from-to)	575-586
ISSN	0009-7322
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.118.036788
Publication status	Published - 2019

Keywords

communicable diseases
heart failure
influenza, human
prognosis
survival
therapeutics
vaccination

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1161/CIRCULATIONAHA.118.036788

Cite this

Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study. Circulation, 139(5), 575-586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788

Modin, D, Jørgensen, ME, Gislason, G, Jensen, JS, Køber, L, Claggett, B, Hegde, SM, Solomon, SD, Torp-Pedersen, C & Biering-Sørensen, T 2019, 'Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study', Circulation, vol. 139, no. 5, pp. 575-586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788

@article{987404f7cf5647029fcb8e68bce3641d,

title = "Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study",

abstract = "Background: Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF. Methods: We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134 048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression. Results: Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7-6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination. Conclusions: In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination.",

keywords = "communicable diseases, heart failure, influenza, human, prognosis, survival, therapeutics, vaccination",

author = "Daniel Modin and J{\o}rgensen, {Mads Emil} and Gunnar Gislason and Jensen, {Jan Skov} and Lars K{\o}ber and Brian Claggett and Hegde, {Sheila M.} and Solomon, {Scott D.} and Christian Torp-Pedersen and Tor Biering-S{\o}rensen",

year = "2019",

doi = "10.1161/CIRCULATIONAHA.118.036788",

language = "English",

volume = "139",

pages = "575--586",

journal = "Circulation",

issn = "0009-7322",

publisher = "AHA/ASA",

number = "5",

}

TY - JOUR

T1 - Influenza Vaccine in Heart Failure

T2 - Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study

AU - Modin, Daniel

AU - Jørgensen, Mads Emil

AU - Gislason, Gunnar

AU - Jensen, Jan Skov

AU - Køber, Lars

AU - Claggett, Brian

AU - Hegde, Sheila M.

AU - Solomon, Scott D.

AU - Torp-Pedersen, Christian

AU - Biering-Sørensen, Tor

PY - 2019

Y1 - 2019

N2 - Background: Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF. Methods: We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134 048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression. Results: Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7-6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination. Conclusions: In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination.

AB - Background: Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF. Methods: We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134 048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression. Results: Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7-6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination. Conclusions: In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination.

KW - communicable diseases

KW - heart failure

KW - influenza, human

KW - prognosis

KW - survival

KW - therapeutics

KW - vaccination

U2 - 10.1161/CIRCULATIONAHA.118.036788

DO - 10.1161/CIRCULATIONAHA.118.036788

M3 - Journal article

C2 - 30586760

AN - SCOPUS:85060567006

SN - 0009-7322

VL - 139

SP - 575

EP - 586

JO - Circulation

JF - Circulation

IS - 5

ER -

Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this