Heart Attack, Stroke Risk Rises After Serious RSV, Study Says

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Heart Attack, Stroke Risk Rises After Serious RSV, Study Says

Level of risk peaked in the week after a hospital admission but lingered through 6 months

Key Takeaways

• In this self-controlled case series, myocardial infarction rates were nearly 9 times greater in the week after an RSV-related hospitalization compared with a control period prior to infection.
• Stroke rates were more than 7 times higher compared with the control period.
• Recent research has suggested that RSV vaccination lowers the risk of cardiorespiratory hospitalizations.

Adults hospitalized with an acute respiratory syncytial virus (RSV) infection may face a sharp risk of cardiorespiratory events such as heart attack or stroke in the weeks afterward, according to a retrospective self-controlled case study.

Compared with a control period preceding infection and after 6 months and beyond, patients had myocardial infarction (MI) rates 2.6 to 8.7 times greater during each of the first 3 weeks following an RSV-related admission (P<0.001 for all), with the level of increased risk highest over those initial 7 days, reported researchers led by Caihua Liang, MD, PhD, of Pfizer in New York City.

Stroke rates increased 7.4-fold in that first week, while rates of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) exacerbations were over 23 times and 12 times higher, respectively. Rates of arrhythmia were 16.5 times greater as well (P<0.001 for all), findings in JAMA Network Open showed. Relative risks remained significant even among patients who had no prior history of cardiorespiratory events.

Adults 75 and older saw even greater cardiorespiratory event risks, with MI rates 10.1 times greater and CHF exacerbation rates 14.6 times greater in the first week after an RSV-related admission (P=0.01 for both).

"Results of our study support a potential role of RSV infection in triggering cardiorespiratory complications in adults, especially older adults, and present a clinical and economic burden beyond the acute phase of the illness," Liang and colleagues wrote. "Additionally, our study highlights the importance of preventive efforts, such as vaccinations, in decreasing the risk of RSV infection and its complications in adults."

RSV infection in the U.S. causes an estimated 100,000 to 150,000 hospitalizations annually among adults 60 and older.

Of note, the current study was sponsored by Pfizer, which markets a bivalent RSV prefusion F vaccine (Abrysvo), one of the three RSV vaccines to have received FDA approval. The CDC currently recommends a one-time dose for all adults 75 and older, as well as a single dose for those ages 50 to 74 who have an increased risk of developing severe disease.

Researchers from Denmark recently reported trial results showing that RSV vaccine recipients were less likely than the unvaccinated to experience all-cause cardiorespiratory hospitalizations.

RSV is not alone, as respiratory illnesses such as influenza and COVID-19 have been linked to greater cardiorespiratory risks.

For their study, Liang and colleagues used the Optum Market Clarity Dataset to analyze 11,887 adult patients ages 18 and older who had an RSV-related hospitalization and a cardiorespiratory event. Cardiorespiratory events included MI (2,421 events), stroke (1,622 events), COPD exacerbations (5,018 events), CHF exacerbations (4,204 events), and arrhythmia (5,844 events).

Patients were their own cases and controls, with two observation periods. The control period included more than 21 days before hospital admission or RSV diagnosis, plus more than 180 days after admission or diagnosis. The case period ran from the date of hospital admission or RSV diagnosis to 180 days after.

Patients' mean age was 69 years, 61% were women.

Post-hospitalization cardiorespiratory event rates at 180 days fell for all conditions, though they remained significantly greater than the control period for stroke (incidence rate ratio 1.6, P<0.001).

The researchers cautioned that the study findings may not be applicable to uninsured populations and that the use of ICD-10-CM codes only to identify cardiorespiratory events may have led to misclassification and bias. In addition, limited RSV testing led to low sensitivity among older adults, which may have excluded some RSV cases with cardiorespiratory events.