Vaccination in Patients with Cardiovascular Disease: A Case-Based Approach and Contemporary Review

Vaccination is a crucial preventative strategy, particularly in individuals with cardiovascular (CV) disease (CVD). People living with CVD are at increased risk of morbidity and mortality from vaccine-preventable infections such as influenza, severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2), respiratory syncytial virus (RSV), varicella zoster virus (VZV), and pneumococcal disease. These infections also have been associated with downstream CV complications, including ischemic events and myocarditis. Randomized controlled trials have demonstrated that influenza vaccination reduces major adverse CV events and all-cause mortality, especially in people with CVD. The same has been observed in registry analyses during the SARS-CoV-2 pandemic. Pooling of data from observational and cohort studies also has shown significant benefit of vaccination against RSV, VZV, and pneumococcal disease in older populations and those with CV comorbidities. Despite recommendations from national public health guidelines and immunization programs, vaccination uptake in patients with CVD remains suboptimal. This low uptake is influenced by lack of vaccine information, access issues, and mistrust in the healthcare system, all summarized in the term "vaccine hesitancy." Vaccination promotion should focus on addressing these gaps in communication and access barriers at the provider, community, and public health levels. Healthcare providers including cardiologists are reminded, through this review, of the importance of emphasizing vaccination recommendations during clinical encounters. Addressing patient misconceptions and providing patient decision aids strongly improves acceptance rates. Continued efforts at the community and public health levels should address barriers to access and advance surveillance methods to target improved clinical outcomes for groups at risk.