Influenza and pneumococcal vaccination in high cardiovascular risk patients: a missed opportunity for prevention?

Abstract Background Influenza and pneumococcal vaccinations have been shown to reduce cardiovascular events, particularly in high-risk patients. Despite this evidence, their cardiovascular benefits are often overlooked by both physicians and patients. In Argentina, these vaccines are provided free of charge to individuals with cardiovascular disease. Purpose To evaluate vaccination rates among adults hospitalized for cardiovascular diseases and assess the association between patients' awareness of the cardiovascular benefits of vaccination and their likelihood of receiving these vaccines. Methods A prospective, multicenter registry was conducted across 30 cardiology centers in Argentina between April 2023 and October 2024. The study included patients hospitalized for cardiovascular diseases, either as emergencies or for scheduled admissions. The study was approved by the Ethics Committee of the Faculty of Medicine, University of Rosario. All participants agreed to participate. Statistical tests were two-sided, with significance set at p<0.05. Results A total of 2,937 patients were included (33.5% women, mean age 69.2 ± 12.1 years). Of these, 63.8% were admitted due to an emergency or decompensation of their underlying condition, and 46.2% were classified as secondary prevention patients. Table 1 summarizes baseline characteristics. Overall, 97.2% of participants had a formal indication for vaccination. However, only 51.7% had received an influenza vaccine in the past year, 49.9% had received a pneumococcal vaccine, and 39.4% had received both vaccines. In contrast, 96.7% had received at least one dose of the COVID-19 vaccine, and 84.2% had received three or more doses. Among unvaccinated patients with a formal indication for vaccination, 74.8% had attended at least one outpatient consultation in the previous year, with 60.8% consulting cardiologists and 41.9% consulting general practitioners. Patients were asked to rate the perceived usefulness of these vaccines in preventing cardiovascular events on a scale of 1 to 10. The mean scores were 4.6 ± 3.4 for influenza and 4.4 ± 3.4 for pneumococcal vaccination. Only 13.9% and 13.1% of participants, respectively, rated these vaccines as highly beneficial (9 or 10 points). Notably, patients who perceived vaccines as highly beneficial had significantly higher vaccination rates (Table 2). Conclusion Influenza and pneumococcal vaccinations remain underutilized preventive strategies in high-risk adults. A substantial proportion of unvaccinated individuals had prior healthcare encounters, representing missed opportunities for prevention. Improving patient awareness of the cardiovascular benefits of vaccination may be key to increasing vaccine uptake among individuals with cardiovascular disease. Additionally, educating clinicians on the cardiovascular benefits of vaccination—beyond infection prevention—could enhance vaccine recommendations and implementation.Table 1