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A powerful drug for HF, but delayed uptake

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Vaccination against SARS-CoV-2 heart failure However, new studies suggest that many of these high-risk patients are hesitant to get vaccinated.

Unvaccinated patients were three times more likely to die of COVID-related illnesses than fully vaccinated patients (hazard ratio). [HR]0.36; 95% CI, 0.30 to 0.43) or vaccine booster (HR, 0.33; 95% CI, 0.23 to 0.48).

There was no significant difference in mortality between partially vaccinated and unvaccinated patients (HR, 0.87; 95% CI, 0.68-1.12).

Patients who were unvaccinated or partially vaccinated were also significantly more likely to be hospitalized (incidence ratio). [IRR]0.68), ICU admission (IRR, 0.63) is required even after adjusting for relevant factors such as age, gender, race / ethnicity. obesityDiabetes, and lung disease.

“Despite the conservative statistical approach, the hazard ratio was impressive,” said Dr. Anura Dalala, MD, lead author of Mount Sinai School of Medicine in New York City. theheart.org | Medscape Cardiology.

Although studies to detect the difference between boosted and fully vaccinated patients were inadequate, the COVID-19 vaccine was followed by full vaccination, partial vaccination, and non-vaccination, most of the time. It seemed to be beneficial to the vaccine booster.

“Since these are observational data, we cannot prove a causal relationship, but they do emphasize the strong protective effect of vaccination against COVID-19 in patients with heart failure,” she said.

Comments on the study for theheart.org | Medscape Cardiology, Ileana LPiña, MD, MPH, Thomas Jefferson University, Philadelphia, and Pennsylvania said this was a single-center study of patients with the Epic Records system, but was conducted during an active period of the pandemic in New York.

“I think this should give people with heart failure comfort to get vaccinated, because it definitely affects how you behave without excessive mortality.” She said.

result, Released on June 9th In Journal of Heart Failure, It was extracted from 7094 patients with heart failure (HF) diagnosis who visited the Mount Sinai Health System between January 1, 2021 and January 24, 2022. The average age was 73 years and 48% were female.

Based on record reviews, 31% of patients were fully vaccinated with two doses and 14.8% were boosted, according to guidance from the Centers for Disease Control and Prevention at the time.

Another 9.1% of patients were partially vaccinated with a single vaccination, while a full 45% had not been vaccinated by January 2022.

Of the 904 patients who died during the 9-month average follow-up, 73.4% were unvaccinated or only partially vaccinated.

Previous studies have shown that patients with HF are at increased risk of complications when infected with COVID and are nearly twice as likely to die as patients without HF. However, Lara observed that the results of the defensive COVID-19 vaccine in HF were not found and were an important impetus to initiate the study.

Early in the deployment of vaccines, expert associations such as the American Heart Failure Society Issued statement It provides a guarantee of vaccine safety, but fear remains.

“As a heart failure cardiologist, I always see patients in the clinic who are afraid of vaccination,” Lara said. “And when I researched and asked why, many of them said:” I already have a history of heart failure, Myocarditis That the vaccine can have a negative effect on my heart. That’s why I don’t want to take that risk. “” “”

“It was difficult to convince some patients that the cardiovascular benefits of vaccination far outweighed the risk of complications due to the lack of specific evidence specific to the heart failure population,” she said. Said.

What cannot be answered in a retrospective study is whether concerns about myocarditis may more resonate with patients with HF or other cardiovascular disease. Patients with chronic illness are generally more likely to be vaccinated than the general population.

On the other hand, there is a lot of false information, and studies show that the risk of myocarditis is about 0.24% for SARS-CoV-2 infection, compared to 0.002% for the COVID-19 vaccine, or about 1/100. Lala is observing that there is.

“In my personal opinion, myocarditis as a result of vaccination is sensational and unrelated to the relative risk of myocarditis and other complications from COVID-19,” she said.

Pinha said she encountered similar resistance and misunderstandings. “They say they don’t want to put the virus in my system because they think the vaccine contains a live virus. This is something we need to dispel what the vaccine is made of.” She said.

To determine if an adverse event is associated with COVID, researchers performed a secondary analysis of encounters with 1767 patients on at least one positive test for SARS-CoV-2.

The results show that SARS-CoV-2 positivity was associated with hospital admission (IRR, 1.67), ICU admission (IRR, 2.01), and mortality (HR, 3.39). P All values ​​<.001).

In patients with positive test results, vaccination status was associated with reduced hospitalization rates (HR, 0.83; P = .02), ICU entry (IRR, 0.57; P = .009), and mortality (HR, 0.35; P = .045) Compared to the unvaccinated state.

“We can’t be satisfied because COVID-19 still depends on us,” Lara said. “I think we often blame patients.’Oh, they refused vaccination’. But they understand their mental barriers, fears and resistance to vaccination and they close those gaps. I think we need to try to fill in with the knowledge and data that can be applied to. “

The authors state that this study did not capture seropositive, hospitalization, or death in other hospital systems. It was not distinguished by whether the patient had HF (HFpEF / HFrEF) with maintained or reduced ejection fraction, or by stage of HF. No data were available for specific treatments for HF or COVID-19.

“They didn’t distinguish between HFrEF and HFpEF, but looking at the population, it’s the population that knows that heart failure can get sick because they’re in the average age range of the 70’s. “Pinha pointed out. “Age alone makes it a vulnerable population and makes it even more valuable.”

“And they had enough women. In most heart failure trials, there were only 20% of women on average, but here there were 48% of women. This is probably a lot here as well. It shows that there is HFpEF, “she said. “So the message to the general public, get vaccinated, your risk is much better to work.”

The study was internally supported. Lala receives personal fees from Zoll in addition to the submitted work. Piña reported that he was on the advisory board of ViForPharma.

J card fails. Published online on June 9, 2022. Full text

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