UCLA

Heart failure affects people of all ages and is the leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are one of the most common causes of hospitalization in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide the best protection against preventable respiratory infections. Despite being an easily accessible intervention, vaccines are underused in patients with heart failure. The purpose of this study was to determine rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure persevered ejection fraction [HFpEF], heart failure mid-range ejection fraction [HFmrEF], heart failure reduced ejection fraction [HFrEF], and heart failure unspecified ejection fraction [HFuEF]), identify patient factors associated with vaccination, and examine the association between provider type (primary care and cardiology) and vaccination status.

An observational study was conducted using data from an academic health system Heart Failure Registry from 2019 to 2022. The conceptual framework used to inform the study was the Chronic Care Model. The Heart Failure Registry contained adult patients (N=7341) with heart failure and data about their demographics, clinical and social characteristics, treatment background, and provider type. Descriptive statistics and frequencies were used to characterize the sample on all analytic variables. Chi square tests were used to compare sample differences by patient and provider factors and vaccination status. Multiple logistic regression models were estimated to examine the odds of vaccination among patients while adjusting for covariates.

Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 54.5% of patients had received an influenza vaccine, 74.7% had received a pneumococcal vaccine, and 81.3% had received a COVID-19 vaccine. Patients with preserved and mid-range heart failure had the highest vaccination levels in all three vaccine groups, while patients with reduced and unspecified heart failure had the lowest odds. Patients with a primary care provider, 65 years and older, Hispanic compared to White, accountable care organization member, or had managed care compared to commercial insurance, had higher odds of receiving all three vaccines. There is a need for individual providers and health systems to develop strategies to overcome heart failure vaccine disparities.