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Vaccination against COVID-19 was associated with significant reductions in serious outcomes among patients with heart failure (HF), according to a retrospective cohort study.

Compared with unvaccinated patients with HF, those who were fully vaccinated (HR 0.36, 95% CI 0.30-0.43) and those who were fully vaccinated and boosted (HR 0.33, 95% CI 0.23-0.48; P<0.001 for both) were less likely to die, reported Anuradha Lala, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues.

Moreover, vaccinated patients were less likely to be hospitalized (incidence rate ratio [IRR] 0.68, 95% CI 0.65-0.71) and admitted to the ICU (IRR 0.63, 95% CI 0.58-0.68, P<0.001 for both) compared with unvaccinated or partially vaccinated patients, the authors wrote in the

"The findings further emphasize that heart failure patients need to take vaccines seriously, since they have worse outcomes if infected with COVID-19, and stresses the importance of receiving the full COVID-19 vaccination dosage, especially since our previous work shows those with heart failure are 2.5 times more likely to die from the virus," Lala said in a statement.

She noted that she has used these results to "educate reluctant patients" about COVID vaccines, and hopes that cardiologists will do the same with their patients, adding that she had heard reports of heart failure patients who were afraid to be vaccinated due to vaccine-associated myocarditis.

"Until now, it has been difficult to explain to these patients how the cardiovascular benefits of vaccination substantially outweigh the risks of complications to them, because we didn't have concrete evidence to show the substantial risks of being unvaccinated, as few studies have focused on this specific high-risk population and COVID-19 vaccinations," she said.

For this study, Lala and colleagues examined data from patients with heart failure in a large New York City health system from Jan. 1, 2021 to Jan. 24, 2022. Patients were eligible if they had an ICD-10 code for a heart failure diagnosis in the past 2 years. Vaccination status was determined via either electronic health record entry or clinician or staff documentation of vaccination "based on patient report and demonstration of vaccine card," they noted.

Overall, 7,094 patients met the criteria: 45.1% were unvaccinated, 31% were vaccinated, 15% were vaccinated and boosted, and 9% were partially vaccinated. Mean age was 73, 52% were men, and 63% had Medicare insurance. Not surprisingly, 78% had "other cardiovascular diseases," 58% had hypertension, and 32% had type 2 diabetes.

The vaccinated and vaccinated/boosted cohorts were slightly older, more likely to be white, and had significantly higher rates of other cardiovascular disease, hypertension, pulmonary disease, and diabetes compared with the unvaccinated and partially vaccinated cohorts.

Over a mean follow-up of about 277 days, 904 patients died. Of these, 73% were either unvaccinated or partially vaccinated.

Limitations to the study included the fact that it was conducted at one center, and patients were not distinguished based on the type or stage of heart failure. In addition, potential unmeasured confounders could have affected the results.

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