Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines–Heart Failure

Ankeet S. Bhatt; Li Liang; Adam D. DeVore; Gregg C. Fonarow; Scott D. Solomon; Orly Vardeny; Clyde W. Yancy; Robert J. Mentz; Yevgeniy Khariton; Paul S. Chan; Roland Matsouaka; Barbara L. Lytle; Ileana L. Piña; Adrian F. Hernandez

doi:10.1016/j.jchf.2018.04.012

Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines–Heart Failure

Ankeet S. Bhatt, Li Liang, Adam D. DeVore, Gregg C. Fonarow, Scott D. Solomon, Orly Vardeny, Clyde W. Yancy, Robert J. Mentz, Yevgeniy Khariton, Paul S. Chan, Roland Matsouaka, Barbara L. Lytle, Ileana L. Piña, Adrian F. Hernandez

Research output: Contribution to journal › Article › peer-review

34 Scopus citations

Abstract

Objectives: This study sought to evaluate and contribute to the limited data on U.S. hospital practice patterns with respect to respiratory vaccination in patients hospitalized with heart failure (HF). Background: Respiratory infection is a major driver of morbidity in patients with HF, and many influenza and pneumococcal infections may be prevented by vaccination. Methods: This study evaluated patients hospitalized at centers participating in the Get With The Guidelines–HF (GWTG-HF) registry from October 2012 to March 2017. The proportion of patients receiving vaccination was described for influenza and pneumococcal vaccination, respectively. The association of hospital-level vaccination rates with individual GWTG-HF performance measures and defect-free care was evaluated using multivariable modeling. Results: This study evaluated 313,761 patients discharged from 392 hospitals during the study period. The proportion of patients receiving influenza vaccination was 68% overall and declined from 70% in 2012 to 2013 to 66% in 2016 to 2017 (p < 0.001), although this was not statistically significant after adjustment (odds ratio: 1.05 per flu season; 95% confidence interval [CI]: 0.94 to 1.18). The proportion of patients receiving pneumococcal vaccination was 66% overall and decreased over the study period from 71% in 2013 to 60% in 2016 (p < 0.001), remaining significant after adjustment (odds ratio: 0.75 per calendar year; 95% CI: 0.67 to 0.84). Hospitals with higher vaccination rates were more likely to discharge patients with higher performance on defect-free care and individual GWTG-HF performance measures (p < 0.001). In a subset of patients with linked Medicare claims, vaccinated patients had similar rates of 1-year all-cause mortality (adjusted hazard ratio: 0.96 [95% CI: 0.89 to 1.03] for influenza vaccination; adjusted hazard ratio: 0.95 [95% CI: 0.89 to 1.01] for pneumococcal vaccination) compared with those not vaccinated. Conclusions: Nearly 1 in 3 patients hospitalized with HF at participating hospitals were not vaccinated for influenza or pneumococcal pneumonia, and vaccination rates did not improve from 2012 to 2017. Hospitals that exhibited higher vaccination rates performed well with respect to other HF quality of care measures. Vaccination status was not associated with differences in clinical outcomes. Further randomized controlled data are needed to assess the relationship between vaccination and outcomes.

Original language	English (US)
Pages (from-to)	844-855
Number of pages	12
Journal	JACC: Heart Failure
Volume	6
Issue number	10
DOIs	https://doi.org/10.1016/j.jchf.2018.04.012
State	Published - Oct 2018
Externally published	Yes

Bibliographical note

Funding Information:
The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. This project was supported by the GWTG-HF program. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. DeVore has received research support from the American Heart Association, Amgen, the National Heart, Lung, and Blood Institute, and Novartis; and consulting fees from Novartis. Dr. Fonarow has received research support from the National Institutes of Health and consulting fees from Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical; and has served on the GWTG Steering Committee. Dr. Solomon has received research support from Novartis and Sanofi Pasteur. Dr. Mentz has received research support from the National Institutes of Health (grants U10HL110312 and R01AG045551-01A1), Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Merck, Novartis, Otsuka, and ResMed; and honoraria from HeartWare, Janssen, Luitpold Pharmaceuticals, Novartis, ResMed, and Thoratec/St. Jude. Dr. Khariton is supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, under award number T32HL110837. Dr. Hernandez has received research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, Sanofi, and Novartis; and honoraria from Bayer, Boston Scientific, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2018

Keywords

heart failure
influenza
performance measures
pneumococcal
vaccination

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Bhatt, A. S., Liang, L., DeVore, A. D., Fonarow, G. C., Solomon, S. D., Vardeny, O., Yancy, C. W., Mentz, R. J., Khariton, Y., Chan, P. S., Matsouaka, R., Lytle, B. L., Piña, I. L., & Hernandez, A. F. (2018). Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines–Heart Failure. JACC: Heart Failure, 6(10), 844-855. https://doi.org/10.1016/j.jchf.2018.04.012

Bhatt, AS, Liang, L, DeVore, AD, Fonarow, GC, Solomon, SD, Vardeny, O, Yancy, CW, Mentz, RJ, Khariton, Y, Chan, PS, Matsouaka, R, Lytle, BL, Piña, IL & Hernandez, AF 2018, 'Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines–Heart Failure', JACC: Heart Failure, vol. 6, no. 10, pp. 844-855. https://doi.org/10.1016/j.jchf.2018.04.012

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title = "Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines–Heart Failure",

abstract = "Objectives: This study sought to evaluate and contribute to the limited data on U.S. hospital practice patterns with respect to respiratory vaccination in patients hospitalized with heart failure (HF). Background: Respiratory infection is a major driver of morbidity in patients with HF, and many influenza and pneumococcal infections may be prevented by vaccination. Methods: This study evaluated patients hospitalized at centers participating in the Get With The Guidelines–HF (GWTG-HF) registry from October 2012 to March 2017. The proportion of patients receiving vaccination was described for influenza and pneumococcal vaccination, respectively. The association of hospital-level vaccination rates with individual GWTG-HF performance measures and defect-free care was evaluated using multivariable modeling. Results: This study evaluated 313,761 patients discharged from 392 hospitals during the study period. The proportion of patients receiving influenza vaccination was 68% overall and declined from 70% in 2012 to 2013 to 66% in 2016 to 2017 (p < 0.001), although this was not statistically significant after adjustment (odds ratio: 1.05 per flu season; 95% confidence interval [CI]: 0.94 to 1.18). The proportion of patients receiving pneumococcal vaccination was 66% overall and decreased over the study period from 71% in 2013 to 60% in 2016 (p < 0.001), remaining significant after adjustment (odds ratio: 0.75 per calendar year; 95% CI: 0.67 to 0.84). Hospitals with higher vaccination rates were more likely to discharge patients with higher performance on defect-free care and individual GWTG-HF performance measures (p < 0.001). In a subset of patients with linked Medicare claims, vaccinated patients had similar rates of 1-year all-cause mortality (adjusted hazard ratio: 0.96 [95% CI: 0.89 to 1.03] for influenza vaccination; adjusted hazard ratio: 0.95 [95% CI: 0.89 to 1.01] for pneumococcal vaccination) compared with those not vaccinated. Conclusions: Nearly 1 in 3 patients hospitalized with HF at participating hospitals were not vaccinated for influenza or pneumococcal pneumonia, and vaccination rates did not improve from 2012 to 2017. Hospitals that exhibited higher vaccination rates performed well with respect to other HF quality of care measures. Vaccination status was not associated with differences in clinical outcomes. Further randomized controlled data are needed to assess the relationship between vaccination and outcomes.",

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author = "Bhatt, {Ankeet S.} and Li Liang and DeVore, {Adam D.} and Fonarow, {Gregg C.} and Solomon, {Scott D.} and Orly Vardeny and Yancy, {Clyde W.} and Mentz, {Robert J.} and Yevgeniy Khariton and Chan, {Paul S.} and Roland Matsouaka and Lytle, {Barbara L.} and Pi{\~n}a, {Ileana L.} and Hernandez, {Adrian F.}",

note = "Funding Information: The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. This project was supported by the GWTG-HF program. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. DeVore has received research support from the American Heart Association, Amgen, the National Heart, Lung, and Blood Institute, and Novartis; and consulting fees from Novartis. Dr. Fonarow has received research support from the National Institutes of Health and consulting fees from Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical; and has served on the GWTG Steering Committee. Dr. Solomon has received research support from Novartis and Sanofi Pasteur. Dr. Mentz has received research support from the National Institutes of Health (grants U10HL110312 and R01AG045551-01A1), Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Merck, Novartis, Otsuka, and ResMed; and honoraria from HeartWare, Janssen, Luitpold Pharmaceuticals, Novartis, ResMed, and Thoratec/St. Jude. Dr. Khariton is supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, under award number T32HL110837. Dr. Hernandez has received research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, Sanofi, and Novartis; and honoraria from Bayer, Boston Scientific, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2018",

year = "2018",

month = oct,

doi = "10.1016/j.jchf.2018.04.012",

language = "English (US)",

volume = "6",

pages = "844--855",

journal = "JACC: Heart Failure",

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TY - JOUR

T1 - Vaccination Trends in Patients With Heart Failure

T2 - Insights From Get With The Guidelines–Heart Failure

AU - Bhatt, Ankeet S.

AU - Liang, Li

AU - DeVore, Adam D.

AU - Fonarow, Gregg C.

AU - Solomon, Scott D.

AU - Vardeny, Orly

AU - Yancy, Clyde W.

AU - Mentz, Robert J.

AU - Khariton, Yevgeniy

AU - Chan, Paul S.

AU - Matsouaka, Roland

AU - Lytle, Barbara L.

AU - Piña, Ileana L.

AU - Hernandez, Adrian F.

N1 - Funding Information: The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. This project was supported by the GWTG-HF program. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. DeVore has received research support from the American Heart Association, Amgen, the National Heart, Lung, and Blood Institute, and Novartis; and consulting fees from Novartis. Dr. Fonarow has received research support from the National Institutes of Health and consulting fees from Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical; and has served on the GWTG Steering Committee. Dr. Solomon has received research support from Novartis and Sanofi Pasteur. Dr. Mentz has received research support from the National Institutes of Health (grants U10HL110312 and R01AG045551-01A1), Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Merck, Novartis, Otsuka, and ResMed; and honoraria from HeartWare, Janssen, Luitpold Pharmaceuticals, Novartis, ResMed, and Thoratec/St. Jude. Dr. Khariton is supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, under award number T32HL110837. Dr. Hernandez has received research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, Sanofi, and Novartis; and honoraria from Bayer, Boston Scientific, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2018

PY - 2018/10

Y1 - 2018/10

N2 - Objectives: This study sought to evaluate and contribute to the limited data on U.S. hospital practice patterns with respect to respiratory vaccination in patients hospitalized with heart failure (HF). Background: Respiratory infection is a major driver of morbidity in patients with HF, and many influenza and pneumococcal infections may be prevented by vaccination. Methods: This study evaluated patients hospitalized at centers participating in the Get With The Guidelines–HF (GWTG-HF) registry from October 2012 to March 2017. The proportion of patients receiving vaccination was described for influenza and pneumococcal vaccination, respectively. The association of hospital-level vaccination rates with individual GWTG-HF performance measures and defect-free care was evaluated using multivariable modeling. Results: This study evaluated 313,761 patients discharged from 392 hospitals during the study period. The proportion of patients receiving influenza vaccination was 68% overall and declined from 70% in 2012 to 2013 to 66% in 2016 to 2017 (p < 0.001), although this was not statistically significant after adjustment (odds ratio: 1.05 per flu season; 95% confidence interval [CI]: 0.94 to 1.18). The proportion of patients receiving pneumococcal vaccination was 66% overall and decreased over the study period from 71% in 2013 to 60% in 2016 (p < 0.001), remaining significant after adjustment (odds ratio: 0.75 per calendar year; 95% CI: 0.67 to 0.84). Hospitals with higher vaccination rates were more likely to discharge patients with higher performance on defect-free care and individual GWTG-HF performance measures (p < 0.001). In a subset of patients with linked Medicare claims, vaccinated patients had similar rates of 1-year all-cause mortality (adjusted hazard ratio: 0.96 [95% CI: 0.89 to 1.03] for influenza vaccination; adjusted hazard ratio: 0.95 [95% CI: 0.89 to 1.01] for pneumococcal vaccination) compared with those not vaccinated. Conclusions: Nearly 1 in 3 patients hospitalized with HF at participating hospitals were not vaccinated for influenza or pneumococcal pneumonia, and vaccination rates did not improve from 2012 to 2017. Hospitals that exhibited higher vaccination rates performed well with respect to other HF quality of care measures. Vaccination status was not associated with differences in clinical outcomes. Further randomized controlled data are needed to assess the relationship between vaccination and outcomes.

AB - Objectives: This study sought to evaluate and contribute to the limited data on U.S. hospital practice patterns with respect to respiratory vaccination in patients hospitalized with heart failure (HF). Background: Respiratory infection is a major driver of morbidity in patients with HF, and many influenza and pneumococcal infections may be prevented by vaccination. Methods: This study evaluated patients hospitalized at centers participating in the Get With The Guidelines–HF (GWTG-HF) registry from October 2012 to March 2017. The proportion of patients receiving vaccination was described for influenza and pneumococcal vaccination, respectively. The association of hospital-level vaccination rates with individual GWTG-HF performance measures and defect-free care was evaluated using multivariable modeling. Results: This study evaluated 313,761 patients discharged from 392 hospitals during the study period. The proportion of patients receiving influenza vaccination was 68% overall and declined from 70% in 2012 to 2013 to 66% in 2016 to 2017 (p < 0.001), although this was not statistically significant after adjustment (odds ratio: 1.05 per flu season; 95% confidence interval [CI]: 0.94 to 1.18). The proportion of patients receiving pneumococcal vaccination was 66% overall and decreased over the study period from 71% in 2013 to 60% in 2016 (p < 0.001), remaining significant after adjustment (odds ratio: 0.75 per calendar year; 95% CI: 0.67 to 0.84). Hospitals with higher vaccination rates were more likely to discharge patients with higher performance on defect-free care and individual GWTG-HF performance measures (p < 0.001). In a subset of patients with linked Medicare claims, vaccinated patients had similar rates of 1-year all-cause mortality (adjusted hazard ratio: 0.96 [95% CI: 0.89 to 1.03] for influenza vaccination; adjusted hazard ratio: 0.95 [95% CI: 0.89 to 1.01] for pneumococcal vaccination) compared with those not vaccinated. Conclusions: Nearly 1 in 3 patients hospitalized with HF at participating hospitals were not vaccinated for influenza or pneumococcal pneumonia, and vaccination rates did not improve from 2012 to 2017. Hospitals that exhibited higher vaccination rates performed well with respect to other HF quality of care measures. Vaccination status was not associated with differences in clinical outcomes. Further randomized controlled data are needed to assess the relationship between vaccination and outcomes.

KW - heart failure

KW - influenza

KW - performance measures

KW - pneumococcal

KW - vaccination

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Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines–Heart Failure

Abstract

Bibliographical note

Keywords

UN SDGs

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