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Docs Overlooking Flu Shots

Posted: Thursday, October 05, 2006

One in three adults with CVD was vaccinated against flu in 2005. One of the biggest barriers is that only about half of all cardiologists in the US stock flu vaccine in their clinics.

The American Heart Association (AHA) and the American College of Cardiology (ACC) have joined forces to advise doctors to administer influenza vaccines to everyone with CVD, because they are missing opportunities to cut deaths and disease due to flu among their patient. Their recommendations are outlined in a scientific advisory published online September 18, 2006 in Circulation, by Dr Matthew M Davis (University of Michigan, Ann Arbor) and colleagues.

"Healthcare providers who treat individuals with cardiovascular disease can help improve influenza-vaccination coverage rates by providing and strongly recommending vaccination to their patients before and throughout the influenza season," Davis et al state. Patients with CVD are more likely to die from flu than people with any other chronic condition, they note, and vaccinating just 60% of the 13.2 million people with heart disease in the US could prevent hundreds of deaths and thousands of cases of flu every year.

Yet just one in three adults with CVD was vaccinated against flu in 2005. One of the biggest barriers is that only about half of all cardiologists in the US stock flu vaccine in their clinics, so the advisory outlines how providers can order influenza vaccine and stresses that immunization is covered by most insurance plans.

A recommendation to vaccinate those with cardiovascular disease against flu was included for the first time in an update to secondary-prevention guidelines for coronary and other vascular diseases issued by the AHA and ACC in May of this year.

The new advisory says that evidence from cohort studies and one randomized clinical trial--FLUVACS--shows that seasonal flu represents a major preventable threat to the health of patients with CVD and that vaccination is associated with a significantly reduced risk of cardiovascular death and nonfatal events. One–year follow-up data from the South American FLUVACS trial showed a 50% reduction in cardiovascular deaths in those vaccinated against the flu.

"Influenza vaccination is now recommended with the same enthusiasm as cholesterol and blood-pressure control and other modifiable risk factors for cardiovascular disease," Davis et al state.

Dr Mohammed Madjid (Texas Heart Institute, Houston), who together with his colleague Dr Ward Casscells (University of Texas, Houston) has spent six years researching this subject and lobbying the AHA and ACC to endorse flu vaccine for patients with coronary heart disease, welcomes the advisory.

Dr Mohammed Madjid states that, "We have shown that flu triggers heart attacks and cardiac patients are undervaccinated and have estimated that influenza can kill up to 91 000 people in the US alone just through triggering fatal heart attacks.

The flu-vaccination season begins in October, and vaccinations of the current year's flu strain should ideally be given by the end of November, the advisory states, although it can be given into January, February, and March, when the flu season peaks. Vaccines can be ordered from three manufacturers in the US.

The advisory warns, however, that the live attenuated nasal vaccine Fluvacs (MedImmune) is contraindicated in CVD patients because it can cause influenza in this high-risk population.

However, Madjid says this decision is misguided: "This is misleading and not based on any evidence. The authors should have been more careful before making this suggestion," he commented.

But Davis states that, "The caution to not use live, attenuated flu vaccine for persons with cardiovascular disease is consistent with existing recommendations from the Centers for Disease Control and Prevention. These recommendations state that, until more data are available regarding the safety of live influenza vaccine for persons at high risk for influenza, inactivated vaccine (administered as an injection) should be used."

He adds, "Our expert committee felt this caution was appropriate because abundant doses of inactivated influenza vaccine are available for persons with cardiovascular disease, which means that it is not likely necessary to opt for the live, attenuated form until its safety has been more broadly established."

Source: Diabetes In Control: 1. Davis MM, Taubert K, Benin AL, et al. Influenza vaccination as secondary prevention for cardiovascular diseased. A science advisory from the American Heart Association/American College of Cardiology. Circulation 2006; 114: 1549-1553. 2. Madjid M, Naghavi M, Litovsky S, et al. Influenza and cardiovascular disease: a new opportunity for prevention and the need for further studies. Circulation 2003; 108: 2730-2736.