COMMENTARY

Get a Flu Shot and Prevent a CV Event -- It's That Simple

Charles P. Vega, MD

Disclosures

March 24, 2014

In This Article

Putting the Evidence Together

The current study suggests that the influenza vaccine can significantly reduce the risk for CV events. But how can clinicians use these important data regarding influenza vaccination and CV risk? One of the most significant applications could come in the form of vaccine promotion, both by counseling individual patients and conducting larger campaigns. There has been a fairly woeful history of interventions to increase the public uptake of influenza vaccination.

Among young people, parent reminders may be modestly effective in improving the rate of vaccination.[8] School-based vaccination programs may be more effective, and programs utilizing live, attenuated influenza vaccine have been demonstrated to promote herd immunity.[9] They are also cost-effective.[10]

Other studies have examined the efficacy of technology in promoting higher rates of influenza vaccination. It makes intuitive sense that people, particularly young people, could respond favorably to such an intervention. However, 2 studies of text messages to promote the influenza vaccine among adolescents and young adults failed to demonstrate a significant difference in vaccination rates.[11,12] Another study of a Web-based initiative among university students resulted in a net increase in vaccine completion of only 6.7%.[13]

Even among healthcare workers, fairly intensive efforts to promote wider vaccination have either failed to improve the rate of vaccination, or resulted in only modest benefits.[14,15]

These studies do not necessarily apply to the need to increase influenza vaccination in patients with CVD, but it cannot hurt to apply the lessons learned. Those at the highest risk for myocardial infarction and stroke should be the patents most likely to take this message to heart. Physicians should particularly identify these individuals and include a description of CV risk as part of shared decision-making regarding the influenza vaccine.

Moreover, an interesting study found that older adults responded more favorably to narrative vs didactic presentations regarding the potential benefits of the influenza vaccine.[16] They rated the narrative information as easier to comprehend and more believable.

So consider weaving a story when your next patient is unsure about what to do regarding vaccination against influenza. And it is okay to include an anecdote about heart disease. Beyond protecting the individual patient, these discussions collectively can improve vaccine coverage and larger community and national health outcomes.

Clinical Pearls

  • Influenza is responsible for millions of hospital inpatient stays annually in the United States and billions of dollars in direct health expenditures alone.

  • Research has found that only 57% of children and adolescents and 38% of adults receive the influenza vaccine, which is far below the goal for vaccine coverage.

  • The current meta-analysis evaluated results from 12 studies. In high-quality research, the influenza vaccine was associated with an overall 36% reduction in the risk for CV events.

  • The influenza vaccine was particularly effective against CV events among patients with a recent history of ACS.

  • The message of how the influenza vaccine may reduce CV risk can be important in promoting wider adoption of the vaccine by patients.

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