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Published on: August 14, 2019
Influenza vaccination in secondary prevention: an opportunity missed
Vera Bittner1, Bonnie K Sanderson
1Division of Cardiovascular Disease, Preventive Cardiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA. vbittner@uab.edu
Insights
Influenza vaccination rates are suboptimal in cardiac rehabilitation patients. Younger, nonwhite individuals without diabetes or COPD are less likely to be vaccinated, necessitating targeted interventions.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Influenza vaccination (FluVacc) is a Class I recommendation for secondary prevention in patients with coronary heart disease (CHD).
- Limited data exists on FluVacc prevalence and its correlates in CHD patients undergoing cardiac rehabilitation.
Purpose of the Study:
- To determine the prevalence and identify independent correlates of influenza vaccination among patients with coronary heart disease in a cardiac rehabilitation program.
Main Methods:
- Analysis of data from 1,051 CHD patients in an academic medical center's cardiac rehabilitation program (1996-2006).
- Comparison of FluVacc proportions across demographic, clinical, and comorbidity subgroups.
- Multivariate logistic regression to identify independent predictors of FluVacc receipt.
Main Results:
- Overall, 52% of patients reported up-to-date FluVacc.
- Independent correlates of FluVacc included older age (OR 2.7), white race (OR 1.5), diabetes (OR 2.2), and chronic obstructive pulmonary disease (OR 1.8).
- Lower vaccination rates were observed in younger, nonwhite patients without diabetes or COPD.
Conclusions:
- Influenza vaccination rates are suboptimal in CHD patients within cardiac rehabilitation settings.
- Targeted interventions are crucial to improve vaccination uptake in underrepresented patient groups.
- Enhancing FluVacc rates can contribute to better secondary prevention outcomes for CHD patients.
Purpose:
Influenza vaccination (FluVacc) has been added as a class I recommendation in the 2006 American Heart Association/American College of Cardiology Secondary Prevention Guidelines. Little is known about prevalence and correlates of FluVacc among patients with coronary heart disease enrolled in cardiac rehabilitation.
Methods:
Data from patients with coronary heart disease enrolled in an academic medical center cardiac rehabilitation program from January 1996 through March 2006 (n = 1,051) were analyzed. The proportions of patients reporting receipt of FluVacc were compared between groups categorized by age (<65 vs 65+ years), sex, race/ethnicity, cardiovascular risk factors, comorbidities, and other clinical characteristics. Multivariate logistic regression modeling was used to determine independent correlates of FluVacc.
Results:
Mean age was 60 +/- 11 years (39%, > or =65 years), 32% were women, 33% nonwhite, 37% had diabetes, 20% smoked, 12% had chronic obstructive pulmonary disease, and 52% reported up-to-date FluVacc. Independent correlates of FluVacc included older age (odds ratio 2.7 [95% confidence interval: 1.9, 3.7], P < .0001), white race (odds ratio 1.5 [95% confidence interval: 1.1, 2.0], P = .018), diabetes (odds ratio 2.2 [95% confidence interval: 1.7, 3.0], P < .0001), and chronic obstructive pulmonary disease (odds ratio 1.8 [95% confidence interval: 1.2, 2.9], P = .011).
Conclusions:
Influenza vaccination rates among patients with coronary heart disease enrolled in cardiac rehabilitation are suboptimal overall, but particularly low for younger, nonwhite patients without diabetes or chronic obstructive pulmonary disease. Interventions designed to increase the rate of FluVacc are needed to improve outcomes among patients with coronary heart disease enrolled in cardiac rehabilitation.
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