Clinical question: How common are acute cardiac events among hospitalized older adults (50 years or older) with respiratory syncytial virus (RSV) infection and what are the associated risk factors?
Background: RSV is a cause of significant morbidity and mortality among adults, particularly older adults and those with chronic medical conditions, and has been associated with acute cardiac events in hospitalized patients. Despite this, more research is needed to better understand the frequency and severity of these events as well as their risk factors.
Study design: Cross-sectional study with detailed clinical data collection for cases identified from RSV Hospitalization Surveillance Network (RSV-NET) surveillance data
Setting: RSV-NET surveillance data in 12 states from five RSV seasons: 2014 to 2015 through 2017 to 2018, and 2022 to 2023
Synopsis: Among the 6,248 hospitalized patients, the weighted period prevalence of an acute cardiac event was 22.4% including 15.8% with acute heart failure, 7.5% with acute ischemic disease, 1.3% with hypertensive crisis, 1.1% with ventricular tachycardia, and 0.6% with cardiogenic shock. In those with prior documented cardiovascular disease, the weighted prevalence was 33.0% compared to 8.5% among those without a documented history. Similarly, the prevalence of acute ischemic heart disease was 10.2% among those with documented prior cardiovascular disease and 4.1% in those without. The risk of developing an acute cardiac event was associated with several risk factors including older age (adjusted relative risk [ARR] of 1.44 for those 85 or older), history of heart failure (ARR of 3.23), and history of diabetes (ARR of 1.18). Among these hospitalized patients with RSV, 18.6% required intensive care unit admission and 6.8% required mechanical ventilation. In multivariate models those with acute cardiac events had higher rates of ICU admission (ARR of 1.54 [95% CI, 1.23 to 1.93]) and mechanical ventilation (ARR of 2.00 [95% CI, 1.44 to 2.79]).
Bottom line: As with other respiratory viruses, acute cardiac events are common in adults 50 years or older hospitalized with RSV infection, particularly those with documented prior cardiovascular disease, and are associated with increased risk of severe outcomes.
Citation: Woodruff RC, Melgar M, et al. Acute cardiac events in hospitalized older adults with respiratory syncytial virus infection. JAMA Intern Med. 2024;184(6):602-11.
Dr. Breslin
Dr. Breslin is a clinical assistant professor in the division of hospital medicine at NYU Grossman School of Medicine in New York.
