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Unvaccinated heart failure patients three times likelier to die from COVID – US study

Heart failure patients unvaccinated against SARS-CoV-2, the virus that causes COVID-19, are three times more likely to die if infected with the virus, compared with fully boosted heart failure patients, shows research from Mount Sinai School of Medicine.

The study, published in the Journal of Cardiac Failure, is the first to look at COVID-19 vaccination status and outcomes in patients with this cardiovascular condition, and shows how dramatic the protective effects are in this high-risk patient population.

The research is important because a number of heart failure patients are hesitant to get the COVID-19 vaccine from a fear of myocarditis, or inflammation of the heart muscle.

This condition is a rare side effect of the Pfizer-BioNTech and Moderna vaccines but a more common complication of COVID-19 infection.

The results of this work can help heart failure patients better understand the benefits of being fully vaccinated and boosted against COVID-19, and the protection it offers.

“Our heart failure patients often fear getting the COVID-19 vaccine after hearing reports of vaccine-related myocarditis, which would cause another cardiac setback for them,” said corresponding author Dr Anurhada Lala, director of Heart Failure Research and an associate professor of medicine (cardiology) at the Icahn School of Medicine at Mount Sinai.

“Until now, it has been difficult to explain to them how the cardiovascular benefits of vaccination substantially outweigh the risks of complications, because we didn’t have concrete evidence to show the substantial risks of being unvaccinated. Few studies have focused on this specific high-risk population and COVID-19 vaccinations.

“Having specific data that shows patients with heart failure who don’t have their full vaccine series have a much higher risk of death, intensive care unit admission, and general hospitalisation – even after accounting for factors that might be related to their decision to become vaccinated – is helpful.”

Mount Sinai researchers looked at electronic records of 7,094 patients from the Mount Sinai Health System with a heart failure diagnosis (not including heart transplant and left ventricular assist device patients) who had office visits, emergency department visits, or hospitalisations between 1 January 2021 and 24 January 2022.

Of that group, 2,200 (31%) were fully vaccinated with two doses, 1,053 (14.8%) were fully vaccinated and had also received one booster – the recommended guidance from the US Centres for Disease Control and Prevention at that time; 645 (9.1%) were partially vaccinated with only one dose, and 3,196 (45%) were unvaccinated.

That unvaccinated proportion in this study is approximately double the proportion of unvaccinated adults in the general New York City population.

Researchers compared survival rates and numbers of admissions to the hospital and intensive care units between the groups, looking at both all-cause mortality and mortality associated with concurrent, documented SARS-CoV-2 infection. They found the unvaccinated and partially vaccinated patients were three times more likely to die from COVID-19-related illness than fully vaccinated and boosted patients.

The study showed that unvaccinated and partially vaccinated patients were 15% likelier to be hospitalised if infected with the virus, and nearly twice as likely to be admitted to the ICU compared with fully vaccinated and boosted patients.

“The findings further emphasise that heart failure patients need to take vaccines seriously, since they have worse outcomes if infected with COVID-19. The research also stresses the importance of receiving the full COVID-19 vaccination dosage, especially since our previous work shows those with heart failure are 2.5 times more likely to die from the virus,” Lala added.

Study details

Association of Reduced Hospitalisations and Mortality Among COVID-19 Vaccinated Patients with Heart Failure

Kipp Johnson, Sonika Patel, Sahityasri Thapi, Suraj Jaladanki, Aarti Rao, Sharon Nirenberg, Anuradha Lala.

Published in the Journal of Cardiac Failure on 9 June 2022


Patients with Heart Failure (HF) are at high risk for adverse outcomes with COVID-19. Reports of COVID-19 vaccine-related cardiac complications may contribute to vaccine hesitancy in patients with heart failure (HF).

To analyse the impact of COVID-19 vaccine status on clinical outcomes in patients with HF, we conducted a retrospective cohort study on the association of COVID-19 vaccination status with hospitalisations, ICU admission, and mortality after adjustment for covariates. Inverse probability treatment weighted (IPTW) models were used to adjust for potential confounding.

Among 7094 patients with HF, 645 (9.1%) were partially vaccinated, 2,200 (31.0%) fully vaccinated, 1,053 vaccine-boosted (14.8%), and 3,196 remained unvaccinated (45.1%) by January 2022. The mean age was 73.3 ± 14.5 years, with 48% female. Lower mortality was observed among patients who were vaccine-boosted followed by those who were fully vaccinated experienced lower mortality (HRs 0.33 (CI 0.23, 0.48) and 0.36 (CI 0.30, 0.43), respectively, compared to unvaccinated individuals, p<0.001) over the mean follow up time of 276.5 ± 104.9 days, while no difference was observed between those who were unvaccinated or only partially vaccinated.

COVID-19 vaccination was associated with significant reduction in all-cause hospitalisation rates and mortality, lending further evidence to support the importance of its implementation in the high-risk population of patients living with HF.


Journal of Cardiac Failure article – Association of Reduced Hospitalisations and Mortality Among COVID-19 Vaccinated Patients with Heart Failure (Open access)


See more from MedicalBrief archives:


People with COVID-19 have higher risk of dying after cardiac arrest — Swedish study


Preliminary results from two UK studies suggest significant heart inflammation from COVID


CDC investigates ‘relatively few’ reports of myocarditis from Pfizer vaccination


Concerns about lasting heart damage in COVID-19 patients — 2 German studies




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