b'Mounting Evidence of RSV Severity Bolsters Argument for VaccinationInfection from the respiratory syncytial virus is usually mild in adults unless they are older or have co-morbidities. A new study revealed that 14.5% of hospitalized adults age 50 years or older with RSV infection experienced acute heart failure, whichwas a higher prevalence than with influenza or COVID-19 infection. The solution, according to public health officials, is for older adults such as the more thanone-third of VHA patients 70 or older, to receive an effective vaccine against RSV.By Brenda L. MooneyATLANTAImmunizationlevelsagainstrespi- the weighted period prevalence and 95% CIs of acute ratorysyncytialvirus(RSV)amongolderadultscardiac events.remained relatively low at around 24% as of lateThe focus was on acute cardiac events, as well as March. As a comparison, national coverage with in- severediseaseoutcomes,includingintensivecare fluenza vaccines for all U.S. adults was 48.3% in theunit (ICU) admission, receipt of invasive mechani-same time period, 2% higher than last year. cal ventilation or in-hospital death. The authors cal-Yet, evidence is mounting that, in many ways, RSVculated adjusted risk ratios (ARR) to compare severe can be as dangerous as influenza and even COVID-19outcomesamongpatientswithandwithoutacute in some situations for older adults. That is especiallycardiac events.the case in a population like the veterans treated by theIncluded in the study were 6,248 hospitalized adults VHA. In 2023, 37% of U.S. military veterans were 70(median[IQR]age,72.7[63.0-82.3]years;59.6% or older, and veterans were more likely to have seri- female;56.4%withunderlyingcardiovasculardis-ous comorbidities that most of the general population. ease) with laboratory-confirmed RSV infection. ThelateststudypointedoutthatwhileitiswellResults indicated that the weighted estimated prev-understood that RSV can cause severe respiratory ill- alenceofexperiencingacardiaceventwas22.4% ness in older adults, not as much is known about the(95%CI,21.0%-23.7%).Theweightedestimated cardiac complications of RSV disease compared withprevalence was 15.8% (95% CI, 14.6%-17.0%) for those of influenza and SARS-CoV-2 infection. acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for Researchers, including participation from the Atlantaacute ischemic heart disease, 1.3% (95% CI, 1.0%-VAMC, sought to describe the prevalence and severity1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-of acute cardiac events during hospitalizations among1.4%) for ventricular tachycardia, and 0.6% (95% CI, adults age 50 years or older with RSV infection. Their0.4%-0.8%) for cardiogenic shock. results appeared in JAMA Internal Medicine. 1 Adults with underlying cardiovascular disease had The cross-sectional study analyzed surveillance dataa greater risk of experiencing an acute cardiac event from the RSV Hospitalization Surveillance Network,relative to those who did not (33.0% vs. 8.5%; ARR, whichconductsdetailedmedicalrecordabstrac- 3.51; 95% CI, 2.85-4.32), the researchers advised. tion among hospitalized patients with RSV infectionAmong all hospitalized adults with RSV infection, detected through clinician-directed laboratory testing.18.6% required ICU admission and 4.9% died during The team examined cases of RSV infection in adultshospitalization. Compared with patients without an age 50 years or older within 12 states over five RSVacute cardiac event, those who experienced an acute seasonsannuallyfrom2014-2015through2017- cardiaceventhadagreaterriskofICUadmission 2018and2022-2023wereexaminedtoestimate(25.8% vs. 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) 3'