European heart journal · 2026
Influenza vaccination, incident atrial fibrillation, and cardiovascular outcomes.
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Fauchier Laurent, Guglieri Mickael, Lenormand Thibault, Bisson Arnaud, Lip Gregory Y H
Аннотация
BACKGROUND AND AIMS: Influenza infection triggers cardiovascular events, and vaccination confers cardiovascular benefit in high-risk populations. Its role in preventing incident atrial fibrillation (AF) and cardiovascular outcomes in clinical practice remains uncertain. These associations were evaluated using a real-world target-trial emulation framework.
METHODS: A retrospective cohort study was conducted using the TriNetX Global Collaborative Federated Research Data Network including adults with a routine healthcare visit in 2022. Influenza vaccination within the preceding year defined exposure; comparators had no recorded vaccination. A 1:1 propensity score matching across 65 baseline variables was applied. Outcomes included incident AF, cardiovascular events, and mortality, with subgroup analyses by age and baseline cardiovascular disease.
RESULTS: After matching, 276 888 patients (138 444 per group) were included with excellent covariate balance. During a mean follow-up of 2.7 ± 0.7 years, influenza vaccination was associated with a significantly lower risk of incident AF [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.76-0.84; P < .0001]. The absolute annualized incidence of AF was 0.9% in vaccinated patients vs 1.1% in non-vaccinated patients. Vaccinated patients also had lower risks of all-cause mortality (HR 0.85, 95% CI 0.82-0.89), myocardial infarction (HR 0.91, 95% CI 0.86-0.97), incident heart failure (HR 0.92, 95% CI 0.88-0.96), and cardiovascular-related hospitalization (HR 0.97, 95% CI 0.95-0.99). Associations were directionally consistent across age and cardiovascular disease subgroups, without significant effect modification.
CONCLUSIONS: In a large retrospective observational real-world cohort, influenza vaccination was associated with lower risks of incident AF and multiple cardiovascular outcomes. These findings support vaccination as a potential upstream strategy for AF prevention and highlight the need for randomized trials specifically designed to address AF-related outcomes.
METHODS: A retrospective cohort study was conducted using the TriNetX Global Collaborative Federated Research Data Network including adults with a routine healthcare visit in 2022. Influenza vaccination within the preceding year defined exposure; comparators had no recorded vaccination. A 1:1 propensity score matching across 65 baseline variables was applied. Outcomes included incident AF, cardiovascular events, and mortality, with subgroup analyses by age and baseline cardiovascular disease.
RESULTS: After matching, 276 888 patients (138 444 per group) were included with excellent covariate balance. During a mean follow-up of 2.7 ± 0.7 years, influenza vaccination was associated with a significantly lower risk of incident AF [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.76-0.84; P < .0001]. The absolute annualized incidence of AF was 0.9% in vaccinated patients vs 1.1% in non-vaccinated patients. Vaccinated patients also had lower risks of all-cause mortality (HR 0.85, 95% CI 0.82-0.89), myocardial infarction (HR 0.91, 95% CI 0.86-0.97), incident heart failure (HR 0.92, 95% CI 0.88-0.96), and cardiovascular-related hospitalization (HR 0.97, 95% CI 0.95-0.99). Associations were directionally consistent across age and cardiovascular disease subgroups, without significant effect modification.
CONCLUSIONS: In a large retrospective observational real-world cohort, influenza vaccination was associated with lower risks of incident AF and multiple cardiovascular outcomes. These findings support vaccination as a potential upstream strategy for AF prevention and highlight the need for randomized trials specifically designed to address AF-related outcomes.