Demographic and Clinical Determinants of Conjugated Pneumococcal Vaccine Uptake and Short-Term All-Cause Mortality in Vaccinated and Unvaccinated Cohorts in Patients with Heart Failure and Reduced Ejection Fraction: A Prospective Cohort Study.

Background and

Objectives

Patients with heart failure (HF) are at risk of increased morbidity and mortality related to pneumococcal pneumonia, and routine vaccination with a conjugated pneumococcal vaccine (PCV) for HF patients is strongly endorsed by all major international guidelines. Despite this, data on the factors associated with vaccine uptake remain scarce. The aim of this study was to understand the demographic and clinical factors associated with vaccine uptake in patients with HF and analyze the all-cause mortality in the vaccinated and unvaccinated cohorts. Materials and

Methods

Four hundred and fifty patients with HF and a reduced ejection fraction followed up at a single center were enrolled. Patients were followed up for a median of 164.0 (148.0-181.0) days.

Results

In total, 193 of the 450 patients (42.9%) were vaccinated with PCV-13 at enrollment. Vaccinated patients were more likely to have an implantable device, namely an implantable cardioverter/defibrillator (ICD), cardiac resynchronization treatment (CRT) or left ventricular assist device (LVAD), and less likely to have a past medical history of hypertension and chronic obstructive pulmonary disease (COPD) at baseline. After multivariable adjustment, the presence of an ICD (OR: 3.17, 95% CI: 1.98-5.08), CRT (OR: 2.75, 95% CI: 1.45-5.20) and COPD (OR: 0.42, 95% CI: 0.19-0.94) remained as determinants of vaccination. All-cause mortality was not different across vaccinated or unvaccinated patients either in the unmatched (log-rank p = 0.67) or matched (log-rank p = 0.52) cohorts.

Conclusions

The presence of implantable devices and coexisting COPD was associated with a higher and lower likelihood of vaccination with PCV-13, respectively. No difference in mortality across cohorts was observed in this observational analysis.