Respiratory syncytial virus (RSV)-related hospitalization and increased rate of cardiovascular events in older adults

Background — Recent studies suggest that respiratory syncytial virus (RSV) can cause severe illness in terms of in-hospital outcomes and mortality. The degree to which RSV hospitalization is associated with cardiovascular outcomes, particularly those known to occur following acute respiratory infections, is poorly described.

Methods — We conducted a retrospective cohort study of adults aged ≥ 65 years hospitalized with a diagnosis of RSV, influenza, urinary tract infection (UTI), or fracture between 2011 and 2020 in Ontario, Canada. Outcomes included subsequent heart failure, myocardial infarction, stroke, or atrial fibrillation events up to 1-year post-discharge, as well as in-hospital and acute outcomes.

Results — Cardiovascular events were subsequently identified in 18.5% (n = 474/2558) of patients who had an RSV-related hospitalization, compared to 17.7% (2961/16,688), 12.1% (8908/73,587), and 8.4% (941/11,262) of patients initially hospitalized with influenza, UTI, or fracture, respectively. In matched analyses, RSV hospitalization was associated with a greater rate of subsequent heart failure events relative to all other patient groups (HR range, 1.48–3.74), both in patients with or without pre-existing cardiovascular conditions. The rate of atrial fibrillation events was also higher in RSV patients, although this was dependent on pre-existing cardiovascular conditions and the comparator group considered. RSV patients were also more likely to be transferred to intensive care (OR range, 1.48–3.55) and had a higher rate of mortality (HR range, 1.49–3.98).

Conclusion — Our findings suggest that RSV is an important determinant of serious post-discharge cardiovascular outcomes in older adults. Further, they underline the importance of vaccination in this population, regardless of pre-existing risk factors.