RSV vaccination was associated with substantially lower all-cause mortality among older adults with heart failure in a multicenter, propensity-matched analysis of U.S. electronic health records.
Researchers identified adults aged 60 years or older with heart failure and compared outcomes according to respiratory syncytial virus vaccination status. After propensity score matching, 777 vaccinated patients and 777 unvaccinated patients had well-balanced baseline demographic characteristics, comorbidities, and medication use.
All-cause mortality occurred in 3.8% of vaccinated patients compared with 11.1% of unvaccinated patients. Vaccination was associated with a 49% lower hazard of death, with a hazard ratio of 0.51 and a 95% confidence interval of 0.33 to 0.79.
ICU admissions were also significantly lower among vaccinated patients, occurring in 2.7% compared with 5.8% of unvaccinated patients. This corresponded to a hazard ratio of 0.46.
However, the study did not identify significant differences in several other clinically important outcomes. Respiratory failure occurred in 7.3% of vaccinated patients and 9.4% of unvaccinated patients, while inpatient or emergency visits occurred in 29.9% and 35.1%, respectively. Neither difference reached statistical significance.
Rates of heart failure exacerbation, myocardial infarction, and stroke were also similar between groups. Age-stratified analyses among patients aged 60 to 75 years and 75 to 90 years showed the same overall pattern, with no significant differences in cardiovascular events.
Overall healthcare utilization was significantly higher in the vaccinated cohort, with a hazard ratio of 1.85. The investigators noted that this may reflect greater engagement with outpatient and nonacute care among people who chose vaccination.
That difference is important when interpreting the mortality finding. Although propensity matching balanced measured characteristics, the observational design could not account for factors such as frailty, heart failure severity, functional status, socioeconomic position, or completeness of guideline-directed therapy.
The authors therefore described the findings as hypothesis-generating rather than evidence of a causal survival benefit. For clinicians caring for older adults with heart failure, the results support further evaluation of RSV vaccination as a strategy that may help reduce the most severe clinical outcomes in a high-risk population.
Reference
Khan A et al. Association of RSV Vaccination With Clinical Outcomes in Older Adults With Heart Failure: A Propensity-Matched Analysis. Clin Cardiol. 2026;49(10).
Featured Image: Syda Productions on Adobe Stock.
Featured Image: Syda Productions on Adobe Stock.
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