Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

Rebecca C Woodruff; Michael Melgar; Huong Pham; Laurence S Sperling; Fleetwood Loustalot; Pam Daily Kirley; Elizabeth Austin; Kimberly Yousey-Hindes; Kyle P Openo; Patricia Ryan; Chloe Brown; Ruth Lynfield; Sarah Shrum Davis; Grant Barney; Brenda Tesini; Melissa Sutton; H Keipp Talbot; Hafsa Zahid; Lindsay Kim; Fiona P Havers

doi:10.1001/jamainternmed.2024.0212

. 2024 Apr 15;184(6):602–611. doi: 10.1001/jamainternmed.2024.0212

Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

Rebecca C Woodruff ^1,^✉, Michael Melgar ², Huong Pham ², Laurence S Sperling ¹, Fleetwood Loustalot ^1,³, Pam Daily Kirley ⁴, Elizabeth Austin ⁵, Kimberly Yousey-Hindes ⁶, Kyle P Openo ^7,^8,⁹, Patricia Ryan ¹⁰, Chloe Brown ¹¹, Ruth Lynfield ¹², Sarah Shrum Davis ¹³, Grant Barney ¹⁴, Brenda Tesini ¹⁵, Melissa Sutton ¹⁶, H Keipp Talbot ¹⁷, Hafsa Zahid ¹⁸, Lindsay Kim ^3,¹⁹, Fiona P Havers ^2,³, for the Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET)

¹Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

²Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

³US Public Health Service Commissioned Corps, Rockville, Maryland

⁴California Emerging Infections Program, Oakland

⁵Colorado Department of Public Health and Environment, Denver

⁶Connecticut Emerging Infections Program, Yale School of Public Health, New Haven

⁷Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia

⁸Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta

⁹Research, Atlanta Veterans Affairs Medical Center, Decatur, Georgia

¹⁰Emerging Infections Program, Maryland Department of Health, Baltimore

¹¹Michigan Department of Health and Human Services, Lansing

¹²Health Protection Bureau, Minnesota Department of Health, St. Paul

¹³New Mexico Emerging Infections Program, University of New Mexico, Albuquerque

¹⁴Division of Epidemiology, New York State Department of Health, Albany

¹⁵School of Medicine and Dentistry, University of Rochester, Rochester, New York

¹⁶Public Health Division, Oregon Health Authority, Portland

¹⁷Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee

¹⁸Epidemiology Bureau, Salt Lake County Health Department, Salt Lake City, Utah

¹⁹Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia

Group Information: Members of the Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET) appear in Supplement 2.

Accepted for Publication: January 15, 2024.

Published Online: April 15, 2024. doi:10.1001/jamainternmed.2024.0212

^✉

Corresponding Author: Rebecca C. Woodruff, PhD, MPH, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Chamblee, GA 30341 (okp9@cdc.gov).

Author Contributions: Dr Woodruff had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Woodruff, Melgar, Talbot, Zahid, Havers.

Acquisition, analysis, or interpretation of data: Woodruff, Melgar, Pham, Sperling, Loustalot, Daily Kirley, Austin, Yousey-Hindes, Openo, Ryan, Brown, Lynfield, Shrum Davis, Barney, Tesini, Sutton, Talbot, Kim, Havers.

Drafting of the manuscript: Woodruff.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Woodruff, Pham.

Obtained funding: Austin, Sutton, Havers.

Administrative, technical, or material support: Loustalot, Openo, Ryan, Brown, Shrum Davis, Barney, Tesini, Sutton, Talbot, Kim.

Supervision: Melgar, Sperling, Tesini, Sutton, Talbot, Havers.

Conflict of Interest Disclosures: Ms Kirley reported receiving funding from the Centers for Disease Control and Prevention (CDC) during the conduct of the study. Ms Austin reported receiving funding from the CDC during the conduct of the study. Ms Yousey-Hindes reported receiving a grant from The Connecticut Emerging Infections Program during the conduct of the study. Dr Openo reported receiving funding from the CDC during the conduct of the study. Dr Ryan reported institutional support from the CDC during the conduct of the study. Ms Brown reported receiving a grant from the Michigan Department of Health and Human Services during the conduct of the study. Dr Lynfield reported receiving a grant from the CDC Emerging Infections Program paid to the Minnesota Department of Health during the conduct of the study and serving as Associate Editor for the American Academy of Pediatrics Red Book–Report of the Committee on Infectious Diseases. Ms Shrum Davis reported receiving a grant from the CDC’s Emerging Infections Program during the conduct of the study. Mr Barney reported receiving funding from the CDC during the conduct of the study. Dr Tesini reported receiving a grant from the CDC during the conduct of the study and personal fees from Merck outside the submitted work. Dr Sutton reported receiving a grant from the CDC’s Emerging Infections Program during the conduct of the study. Dr Talbot reported receiving a grant from the CDC during the conduct of the study. Ms Zahid reported receiving funding from the CDC during the conduct of the study. No other disclosures were reported.

Funding/Support: This work was supported by the CDC through an Emerging Infections Program cooperative agreement (grant CK17-1701) and through a Council of State and Territorial Epidemiologists cooperative agreement (grant NU380T000297-02-00).

Role of the Funder/Sponsor: The CDC was involved with the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET) Group Members are listed in Supplement 2.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Data Sharing Statement: See Supplement 3.

^✉

Corresponding author.

PMCID: PMC11019447 PMID: 38619857

This cross-sectional study examines the frequency and severity of acute cardiac events in hospitalized adults aged 50 years or older with respiratory syncytial virus infection.

Key Points

Question

What are the frequency and severity of acute cardiac events among hospitalized adults aged 50 years or older with laboratory-confirmed respiratory syncytial virus (RSV) infection?

Findings

In this cross-sectional study of 6248 hospitalized adults with RSV infection, 22% of patients experienced an acute cardiac event, most often acute heart failure (16%). Acute cardiac events occurred more often among those with (33%) vs without (9%) underlying cardiovascular disease and were associated with nearly twice the risk of severe outcomes.

Meaning

Findings of this study suggest acute cardiac events are common among hospitalized older adults with RSV infection and are associated with severe clinical outcomes.

Abstract

Importance

Respiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection.

Objective

To describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection.

Design, Setting, and Participants

This cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected through clinician-directed laboratory testing. Cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (annually from 2014-2015 through 2017-2018 and 2022-2023) were examined to estimate the weighted period prevalence and 95% CIs of acute cardiac events.

Exposures

Acute cardiac events, identified by International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification discharge codes, and discharge summary review.

Main Outcomes and Measures

Severe disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events.

Results

The study included 6248 hospitalized adults (median [IQR] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock. Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs 4.0%; ARR, 1.77; 95% CI, 1.36-2.31).

Conclusions and Relevance

In this cross-sectional study over 5 RSV seasons, nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.

Introduction

Respiratory syncytial virus (RSV) is a seasonal respiratory virus that usually causes mild upper respiratory tract symptoms but can cause severe lower respiratory tract disease in high-risk groups. Among adults, older age and history of chronic medical conditions, including heart failure and coronary artery disease, are risk factors for severe RSV illness requiring hospitalization.^1,2,3,4,5,6 Respiratory syncytial virus has been associated with annual totals of up to 160 000 hospitalizations, 10 000 deaths, and $4.0 billion in direct health care costs among US adults age 65 years or older.^{4,7,8,9,10,11,12} However, despite evidence of considerable RSV-associated morbidity, mortality, and health care expenditure, the potential severity of RSV infection in adults has historically been underappreciated by public health professionals and clinicians.^13,14 Surveillance for RSV-associated illness in adults has been hampered by infrequent clinical testing,¹⁵ as clinicians may choose not to test because of limited awareness of RSV as an important pathogen in adults and because an RSV diagnosis does not typically change patient management. Additionally, until recently, limited tools were available to prevent RSV infection, although this changed in 2023 when the first RSV vaccines for adults aged 60 years or older were approved and recommended in the US via the use of shared clinical decision-making, which takes into account the risks and benefits of RSV disease and vaccination, the clinician’s knowledge and experience, and the patient’s values and preferences.^11,16,17

Respiratory viral diseases, including influenza and COVID-19, have been associated with acute cardiovascular disease and mortality through ecological analyses and hospital-based surveillance.^{18,19,20,21,22} Emerging evidence raises concerns about acute cardiac events as potential complications of RSV infection as well, especially among older adults.^{23,24,25,26,27,28,29} Cardiac complications occur in 14% to 22% of older adults hospitalized with RSV and include heart failure exacerbation, acute coronary syndrome, and arrhythmias.^{23,24,25,26,27,28,29} However, these estimates relied primarily on single-center studies with limited sample sizes and did not examine risk factors for experiencing an acute cardiac event or the severity of these events when they occur. Comprehensive data about potential cardiac complications of RSV infection, similar to what are available for hospitalizations for influenza or SARS-CoV-2 infections,^18,19 could help guide clinical and public health practices, characterize the burden of RSV-associated cardiovascular disease prior to the introduction of novel vaccines, and prompt studies evaluating the prevention of acute cardiac events through RSV vaccination.³⁰

The primary objective of this study was to estimate the period prevalence of acute cardiac events among hospitalized adults aged 50 years or older with RSV infection. Secondary objectives were to identify risk factors for experiencing an acute cardiac event and to determine whether acute cardiac events are independently associated with increased risk of severe outcomes. We chose to focus on adults aged 50 years or older, as they account for over 90% of RSV-associated hospitalizations of adults in the US,⁴ and in light of emerging clinical trial data in adults aged 50 to 59 years, which could expand RSV vaccination to younger age groups.³¹ Additionally, we sought to identify risk factors for experiencing an acute cardiac event and to determine whether acute cardiac events are independently associated with increased risk of severe outcomes during hospitalization.

Methods

Participants and Procedures

The RSV Hospitalization Surveillance Network (RSV-NET) is 1 of 3 Centers for Disease Control and Prevention (CDC)–supported Respiratory Virus Hospitalization Surveillance Network platforms that conduct population-based surveillance for hospitalizations associated with RSV, COVID-19 (COVID-NET), and influenza (FluSurv-NET). The RSV-NET conducts population-based surveillance of hospitalizations for patients with laboratory-confirmed RSV infection during annual RSV seasons (typically October to April). The RSV-NET geographic catchment area has expanded over time; during the 2022 to 2023 season, it included 58 counties in 12 geographically diverse US states (California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Tennessee, and Utah), representing approximately 8% of the US population. The CDC deemed the data collection activities of RSV-NET to be nonresearch public health surveillance and exempt from review and patient informed consent. Each RSV-NET site obtained approval from its respective state and local institutional review boards as required. This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.³² Data collection and abstraction activities were conducted in concordance with applicable federal law and CDC policy.³³

Cases in RSV-NET were residents of the surveillance catchment area hospitalized for any acute medical reason, with RSV detected primarily by clinician-ordered molecular tests (<2% of cases were detected by antigen, viral culture, fluorescent antibody, or serology tests) within 14 days of hospital admission. This analysis used data from all surveillance seasons when RSV-NET collected detailed clinical information from adult RSV-NET cases through medical record abstraction (eTable 1 in Supplement 1). Detailed clinical information was collected from all adult RSV-NET cases between the 2014 to 2015 and the 2017 to 2018 annual seasons. In the 2022 to 2023 season, RSV-NET collected detailed clinical information from a random sample of adult cases rather than for all cases. The random sample of adult cases was selected with variable probability of selection by surveillance month, RSV-NET site, and age group. Although RSV-NET conducted surveillance from the 2018 to 2019 season to the 2021 to 2022 season, we omitted data from those seasons because detailed clinical information was abstracted only for adult patients with severe outcomes (eg, admitted to the intensive care unit [ICU] or died during hospitalization).

For cases selected for detailed clinical data collection, trained surveillance officers abstracted information from the medical record onto a standardized case report form. Abstracted information included demographic characteristics, underlying medical conditions, clinical characteristics, in-hospital interventions and outcomes, discharge diagnoses listed in the discharge summary, and the first 9 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) discharge codes.

Among 6349 hospitalized adults aged 50 years or older with laboratory-confirmed RSV infection who were eligible for medical record abstraction, 6248 (98.4%) were included in the analysis. Reasons for exclusion included incomplete medical record abstraction or missing discharge summary and ICD-9-CM or ICD-10-CM codes for discharge diagnoses at the time of analysis; eFigure and eTable 2 in Supplement 1.

Demographic Characteristics

Age group (50-64, 65-74, 75-84, and ≥85 years), sex (female or male), and race and Hispanic ethnicity group (Hispanic, non-Hispanic Asian or Pacific Islander [hereafter, Asian or Pacific Islander], non-Hispanic Black [hereafter, Black], non-Hispanic White [hereafter, White], or non-Hispanic other race and ethnicity [including American Indian or Alaska Native, multiracial, and unknown) were abstracted from the medical record. Information on race and ethnicity was conceptualized as a social construct, with potential differences in both exposures and outcomes signifying differences in underlying socioeconomic drivers of health disparities, not innate differences between subgroups.

Clinical Characteristics and Severe Outcomes

A history of select underlying medical conditions documented in the medical record was identified through review of the admission history and physical examination, the emergency department report, consultation notes, and discharge summary. Select results were stratified by history of underlying cardiovascular disease, defined by the following conditions: aortic aneurysm, aortic stenosis, atrial fibrillation, coronary artery disease, congenital heart disease, heart failure, or other cardiac disease (eTable 4 in Supplement 1). Eight categories of underlying conditions were evaluated as potential risk factors for acute cardiac events: atrial fibrillation, coronary artery disease, heart failure, cerebrovascular accident, diabetes (type 1 or type 2), chronic obstructive pulmonary disease, chronic kidney disease, and severe obesity (body mass index ≥40; calculated as weight in kilograms divided by height in meters squared) (eTable 4 in Supplement 1). Acute respiratory and nonrespiratory signs and symptoms at admission that occurred within 2 weeks prior to the positive RSV test were also abstracted (shortness of breath or respiratory distress, cough, upper respiratory tract symptoms, wheezing, and fever or chills). History of tobacco use (current; former; or never or unknown) was also collected.

Patients were defined as having an acute cardiac event if they had at least 1 of the following: (1) an ICD-9-CM or ICD-10-CM primary or secondary discharge code indicative of an acute cardiac event (eTable 3 in Supplement 1) or (2) heart failure, myocardial infarction, or myocarditis listed as new diagnoses or exacerbations of preexisting diagnoses in the discharge summary. Similar to previous analyses,^18,19 we limited the acute cardiac event definition to conditions with the terms acute, acute-on-chronic, or exacerbation or those that are inherently acute events, and excluded conditions that could not be confidently differentiated from stable chronic conditions (eg, atrial fibrillation). Acute cardiac events were further categorized into the following nonmutually exclusive categories: acute heart failure, acute ischemic heart disease, ventricular tachycardia, hypertensive crisis, cardiogenic shock, and other acute cardiac events (eg, stress cardiomyopathy, viral cardiomyopathy, myocarditis, pericarditis, and endocarditis). Patients were defined as having a severe outcome if they experienced ICU admission, received invasive mechanical ventilation, or died during hospitalization. Lengths of hospital and ICU stays in days were also abstracted.

Statistical Analysis

Data were analyzed using survey procedures in SAS, version 9.4 (SAS Institute Inc) that included sample weights to account for the probability of selection for medical chart abstraction. We calculated the unadjusted period prevalence of acute cardiac events among patients aged 50 years or older overall and stratified by history of underlying cardiovascular disease, with 95% CIs calculated using binomial proportions. Bivariate and multivariable log-linked Poisson generalized estimating equations used robust estimators to account for geographic clustering of hospitalizations within RSV-NET sites and identified demographic characteristics and underlying medical conditions associated with greater risk of experiencing an acute cardiac event both overall and stratified by history of underlying cardiovascular disease. A similar modeling approach estimated the association between experiencing an acute cardiac event (overall and by event category) and severe outcomes. Multivariable models included the following independent variables: surveillance season, age group, sex, race and Hispanic ethnicity group, underlying medical conditions, and history of tobacco use. All models present the adjusted risk ratio (ARR), 95% CIs, and P values using a type I error rate of 5% adjustment for multiple comparisons.

We also conducted sensitivity analyses excluding the 2022 to 2023 RSV surveillance season because of differences in the demographic and clinical characteristics of RSV-NET cases aged 50 years or older hospitalized during the 2014 to 2015 through the 2017 to 2018 surveillance seasons compared with the 2022 to 2023 season (eTable 5 in Supplement 1), which were potentially associated with changes in testing practices for respiratory viruses during the COVID-19 pandemic. Findings were similar regardless of whether the 2022 to 2023 data were included in analyses.

Results

In all, the study included 6248 hospitalized with laboratory-confirmed RSV infection (median [IQR] age was 72.7 [63.0-82.3] years; 59.6% female and 40.4% male [percentages weighted]) with laboratory-confirmed RSV infection (Table 1). The largest race and ethnicity group was White (65.9%), followed by Black (16.0%), Asian or Pacific Islander (7.3%), and Hispanic or Latino (6.6%). Most patients (56.4%) had a history of cardiovascular disease noted in the medical record, including heart failure (31.9%), coronary artery disease (30.2%), and atrial fibrillation (25.2%). A history of smoking (36.8%) or current smoking (15.7%) was common. Most adults (93.1%) had fever or respiratory symptoms noted in the medical record at admission.

Table 1. Characteristics of Hospitalized Adults With RSV Infection by Acute Cardiac Event Status.

Characteristic	Adults aged ≥50 y with laboratory-confirmed RSV infection, unweighted No. (weighted %)			P value^a
Characteristic	Overall (N = 6248)	With ≥1 acute cardiac event (n = 1383)	Without acute cardiac event (n = 4865)	P value^a
RSV surveillance season
2014-2015	360 (4.7)	82 (4.8)	278 (4.7)	.69
2015-2016	649 (8.5)	113 (6.6)	536 (9.0)	.25
2016-2017	1107 (14.5)	238 (13.9)	869 (14.7)	.20
2017-2018	2194 (28.7)	472 (27.7)	1722 (29.0)	.20
2022-2023	1938 (43.6)	478 (47.0)	1460 (42.6)	.02
Age group, y
50-64	1807 (27.4)	303 (20.8)	1504 (29.3)	<.001
65-74	1659 (26.3)	344 (24.9)	1315 (26.7)	.28
75-84	1482 (25.4)	377 (28.0)	1105 (24.7)	.02
≥85	1300 (20.9)	359 (26.3)	941 (19.4)	<.001
Sex
Female	3695 (59.6)	779 (56.1)	2916 (60.6)	<.001
Male	2553 (40.4)	604 (43.9)	1949 (39.4)	<.001
Race and ethnicity
Asian American or Pacific Islander	439 (7.3)	78 (6.1)	361 (7.8)	.45
Black	1018 (16.0)	250 (17.9)	768 (15.4)	.13
Hispanic or Latino	367 (6.6)	69 (5.3)	298 (7.0)	.24
White	4138 (65.9)	908 (65.5)	3230 (66.1)	.39
Other^b	286 (4.2)	78 (5.3)	208 (3.9)	.70
Underlying conditions^c
Cardiovascular disease^d	3564 (56.4)	1141 (83.3)	2423 (48.7)	<.001
Heart failure^e	1990 (31.9)	903 (65.0)	1087 (22.4)	<.001
Coronary artery disease^f	1967 (30.2)	598 (42.7)	1369 (26.6)	<.001
Atrial fibrillation	1603 (25.2)	563 (39.1)	1040 (21.2)	<.001
Diabetes (type 1 or 2)	2240 (35.0)	614 (44.1)	1626 (32.3)	<.001
COPD^g	2165 (34.2)	506 (37.7)	1659 (33.2)	.09
Chronic kidney disease^h	1793 (28.5)	537 (38.9)	1256 (25.5)	<.001
Cerebrovascular accident or stroke	761 (11.9)	190 (13.8)	571 (11.3)	.02
Severe obesityⁱ	566 (9.6)	145 (10.3)	421 (9.4)	.25
Tobacco use
No or unknown	2925 (47.5)	655 (46.1)	2270 (47.9)	.57
Former	2299 (36.8)	530 (40.3)	1769 (35.9)	.02
Current	1024 (15.7)	198 (13.6)	826 (16.3)	.05
Signs and symptoms at admission
Fever or any respiratory symptom	5895 (93.1)	1321 (95.2)	4574 (92.6)	NA
Any respiratory symptom	5797 (91.5)	1307 (94.2)	4490 (90.8)	NA
Shortness of breath	4651 (74.2)	1122 (81.8)	3529 (71.9)	NA
Cough	5085 (80.6)	1100 (80.7)	3985 (80.5)	NA
Wheezing	2261 (35.7)	491 (36.5)	1770 (35.5)	NA
URI/ILI	729 (11.8)	162 (13.0)	567 (11.4)	NA
Fever or chills	2701 (41.2)	480 (33.9)	2221 (43.2)	NA

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Abbreviations: COPD, chronic obstructive pulmonary disease; NA, not applicable; RSV, respiratory syncytial virus; URI/ILI, upper respiratory tract infection/influenzalike illness.

^{^a}

P values are derived from bivariate generalized estimating equation models that account for clustering by Respiratory Syncytical Virus Hospitalization Surveillance Network site.

^{^b}

Includes American Indian or Alaska Native, multiracial, and unknown race and ethnicity.

^{^c}

For each medical condition, no or unknown history of the condition was used as the reference group.

^{^d}

Includes aortic aneurysm, aortic stenosis, atrial fibrillation, coronary artery disease, congenital heart disease, heart failure, or other cardiac disease.

^{^e}

Includes heart failure and cardiomyopathy.

^{^f}

Includes coronary artery disease and atherosclerotic cardiovascular disease.

^{^g}

Includes emphysema or COPD and chronic bronchitis.

^{^h}

Includes chronic kidney disease or chronic renal insufficiency and end-stage renal disease or dialysis.

^ⁱ

Defined as a body mass index ≥40 (calculated as weight in kilograms divided by height in meters squared) or International Classification of Diseases, 10th Revision, Clinical Modification codes for severe obesity.

Period Prevalence of Acute Cardiac Events

The weighted estimated period prevalence of experiencing an acute cardiac event among adults aged 50 years or older hospitalized with laboratory-confirmed RSV infection was 22.4% (95% CI, 21.0%-23.7%; Table 2). Acute heart failure was the most frequently occurring category of acute cardiac event, with a weighted estimated prevalence of 15.8% (95% CI, 14.6%-17.0%). The weighted estimated prevalence of acute ischemic heart disease in hospitalized patients was 7.5% (95% CI, 6.8%-8.3%); ST-segment elevation myocardial infarction occurred in 3.0% of patients with acute ischemic heart disease. Less frequently occurring acute cardiac events included hypertensive crisis (weighted estimated prevalence, 1.3%; 95% CI, 1.0%-1.7%), ventricular tachycardia (weighted estimated prevalence, 1.1%; 95% CI, 0.8%-1.4%), and cardiogenic shock (weighted estimated prevalence, 0.6%; 95% CI, 0.4-0.8). Of the 94 hospitalizations with other acute cardiac events (weighted estimated prevalence, 1.3%; 95% CI, 1.0%-1.6%), acute myocarditis occurred in 7 patients.

Table 2. Period Prevalence of Acute Cardiac Events Among Hospitalized Adults With RSV Infection.

Cardiac event	Adults aged ≥50 y with laboratory-confirmed RSV infection
	Overall (N = 6248)		Without documented underlying cardiovascular disease (n = 2684)^a		With ≥1 underlying cardiovascular disease (n = 3564)^a
	Unweighted No.	Weighted prevalence (95% CI), %	Unweighted No.	Weighted prevalence (95% CI), %	Unweighted No.	Weighted prevalence (95% CI), %
≥1 Acute cardiac event	1383	22.4 (21.0-23.7)	242	8.5 (7.4-9.8)	1141	33.0 (31.0-35.2)
Acute heart failure	965	15.8 (14.6-17.0)	97	3.5 (2.8-4.3)	868	25.3 (23.4-27.2)
Acute ischemic heart disease	468	7.5 (6.8-8.3)	120	4.1 (3.3-5.0)	348	10.2 (9.0-11.5)
Hypertensive crisis	76	1.3 (1.0-1.7)	40	1.6 (1.0-2.3)	36	1.1 (0.7-1.6)
Ventricular tachycardia	73	1.1 (0.8-1.4)	15	0.5 (0.3-0.8)	58	1.6 (1.2-2.1)
Cardiogenic shock	40	0.6 (0.4-0.8)	7	0.2 (0.1-0.5)^b	33	0.8 (0.6-1.2)
Other acute cardiac event^c	94	1.3 (1.0-1.6)	26	0.9 (0.6-1.4)	68	1.6 (1.2-2.1)
No acute cardiac events	4865	77.7 (76.3-79.0)	2442	91.5 (90.2-92.6)	2423	67.0 (64.9-69.0)

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Abbreviation: RSV, respiratory syncytial virus.

^{^a}

Underlying cardiovascular disease includes history of heart failure, coronary artery disease, atrial fibrillation, atherosclerotic cardiovascular disease, cardiomyopathy, aortic aneurysm, congenital heart disease, aortic stenosis, and other cardiac disease.

^{^b}

Relative standard error >0.3.

^{^c}

Includes stress cardiomyopathy, viral cardiomyopathy, myocarditis, pericarditis, and endocarditis.

Relative to patients with no documented history of cardiovascular disease, patients with underlying cardiovascular disease had a greater weighted estimated period prevalence of experiencing an acute cardiac event of any category (33.0% vs 8.5%; ARR, 3.51 [95% CI, 2.85-4.32]), acute heart failure (25.3% vs 3.5%; ARR, 5.89 [95% CI, 4.30-8.08]), and acute ischemic heart disease (10.2% vs 4.1%; ARR, 2.38 [95% CI, 1.84-3.09]). Additionally, the weighted estimated period prevalences of acute cardiac events and acute heart failure were higher among adults in older age groups (Table 3 and eTable 6 in Supplement 1).

Table 3. Risk Factors for Acute Cardiac Events, Acute Heart Failure, and Acute Ischemic Heart Disease Among Hospitalized Adults With RSV Infection^a.

Factor	Adults aged ≥50 y with laboratory-confirmed RSV infection
	Overall (N = 6248)		With acute heart failure (n = 6248)		With acute ischemic heart disease (n = 6248)
	ARR (95% CI)	P value	ARR (95% CI)	P value	ARR (95% CI)	P value
Age group, y
50-64	1 [Reference]	NA	1 [Reference]	NA	1 [Reference]	NA
65-74	1.10 (0.96-1.26)	.15	1.17 (0.99-1.37)	.06	1.12 (0.85-1.49)	.42
75-84	1.20 (1.01-1.42)	.04	1.22 (1.01-1.49)	.04	1.33 (0.98-1.80)	.06
≥85	1.44 (1.20-1.73)	<.001	1.56 (1.21-2.02)	<.001	1.24 (0.83-1.84)	.29
Sex
Female	1 [Reference]	NA	1 [Reference]	NA	1 [Reference]	NA
Male	1.12 (1.00-1.25)	.06	1.16 (1.05-1.29)	<.001	1.11 (0.91-1.36)	.29
Race and ethnicity
Asian American or Pacific Islander	0.96 (0.84-1.09)	.49	0.96 (0.74-1.24)	.75	1.01 (0.74-1.38)	.96
Black	1.16 (0.98-1.36)	.08	1.14 (0.91-1.43)	.25	1.16 (0.96-1.40)	.13
Hispanic or Latino	0.92 (0.72-1.19)	.53	1.02 (0.77-1.35)	.88	0.57 (0.32-1.01)	.06
White	1 [Reference]	NA	1 [Reference]	NA	1 [Reference]	NA
Other^b	1.29 (0.97-1.72)	.08	1.33 (0.86-2.06)	.20	1.29 (0.89-1.85)	.18
Underlying conditions^c
Heart failure^d	3.23 (2.83-3.69)	<.001	5.36 (3.97-7.23)	<.001	1.85 (1.52-2.25)	<.001
Atrial fibrillation	1.18 (1.08-1.30)	<.001	1.32 (1.12-1.55)	<.001	0.85 (0.65-1.11)	.23
Coronary artery disease^e	1.22 (1.00-1.48)	.05	1.10 (0.92-1.32)	.31	1.52 (1.08-2.13)	.02
Diabetes (type 1 or 2)	1.18 (1.06-1.31)	<.001	1.22 (1.05-1.42)	.01	1.20 (0.91-1.59)	.20
Chronic kidney disease^f	1.03 (0.89-1.19)	.69	1.09 (0.99-1.20)	.09	0.99 (0.75-1.30)	.93
COPD^g	0.97 (0.86-1.09)	.58	0.99 (0.87-1.14)	.94	0.96 (0.72-1.28)	.79
Cerebrovascular accident or stroke	0.92 (0.82-1.03)	.14	0.89 (0.81-0.97)	.01	0.81 (0.64-1.02)	.07
Severe obesity^h	1.00 (0.85-1.17)	.98	1.13 (0.98-1.31)	.10	0.83 (0.62-1.16)	.52
Tobacco use
No or unknown	1 [Reference]	NA	1 [Reference]	NA	1 [Reference]	NA
Former	0.98 (0.91-1.06)	.68	1.01 (0.89-1.14)	.86	0.93 (0.75-1.12)	.22
Current	1.05 (0.87-1.26)	.60	1.05 (0.87-1.27)	.60	1.08 (0.79-1.49)	.62
Surveillance season
2014-2015	1 [Reference]	NA	1 [Reference]	NA	1 [Reference]	NA
2015-2016	0.82 (0.66-1.02)	.07	0.83 (0.68-1.00)	.05	0.87 (0.67-1.12)	.28
2016-2017	0.92 (0.70-1.22)	.57	0.91 (0.71-1.16)	.47	0.94 (0.58-1.53)	.82
2017-2018	0.91 (0.71-1.17)	.46	0.87 (0.70-1.10)	.25	1.21 (0.82-1.77)	.34
2022-2023	1.07 (0.80-1.43)	.64	1.04 (0.85-1.27)	.73	1.30 (0.89-1.89)	.17

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Abbreviations: ARR, adjusted risk ratio; COPD, chronic obstructive pulmonary disease; NA, not applicable; RSV, respiratory syncytial virus.

^{^a}

Multivariable models are adjusted for surveillance season, age group, sex, race and Hispanic ethnicity group, underlying medical conditions, and history of tobacco use.

^{^b}

Includes American Indian or Alaska Native, multiracial, and unknown race and ethnicity.

^{^c}

For each medical condition, no or unknown history of the condition was used as the reference group.

^{^d}

Includes heart failure and cardiomyopathy.

^{^e}

Includes coronary artery disease and atherosclerotic cardiovascular disease.

^{^f}

Includes chronic kidney disease or chronic renal insufficiency and end-stage renal disease or dialysis.

^{^g}

Includes emphysema or COPD and chronic bronchitis.

^{^h}

Defined as body mass index ≥40 (calculated as weight in kilograms divided by height in meters squared) or International Classification of Diseases, 10th Revision, Clinical Modification codes for severe obesity.

Risk Factors for Acute Cardiac Events

The risk of experiencing an acute cardiac event was greater among patients aged 85 years or older compared with those aged 50 to 64 years (ARR, 1.44; 95% CI, 1.20-1.73) and in those with a history of heart failure (ARR, 3.23; 95% CI, 2.83-3.69), atrial fibrillation (ARR, 1.18; 95% CI, 1.08-1.30), or diabetes (ARR, 1.18; 95% CI, 1.06-1.31) (Table 3). The risk of experiencing acute heart failure was greater among patients aged 75 to 84 years (ARR, 1.22; 95% CI, 1.01-1.49) or 85 years or older (ARR, 1.56; 95% CI, 1.21-2.02) compared with those aged 50 to 64 years, males compared with females (ARR, 1.16; 95% CI, 1.05-1.29), and in those with a history of heart failure (ARR, 5.36; 95% CI, 3.97-7.23), atrial fibrillation (ARR, 1.32; 95% CI, 1.12-1.55), or diabetes (ARR, 1.22; 95% CI, 1.05-1.42). The risk of experiencing acute ischemic heart disease was greater among patients with a history of heart failure (ARR, 1.85; 95% CI, 1.52-2.25) or coronary artery disease (ARR, 1.52; 95% CI, 1.08-2.13). In stratified analyses, risk factors for experiencing an acute cardiac event varied among patients with vs without a history of chronic cardiovascular disease, but age 85 years or older was a consistent risk factor (eTable 7 in Supplement 1).

Acute Cardiac Events and Severe Outcomes

Among hospitalized adults aged 50 years or older with laboratory-confirmed RSV infection, 18.6% required ICU admission, 6.8% required invasive mechanical ventilation, and 4.9% died during hospitalization (Table 4). In multivariable models, hospitalized patients with RSV infection who experienced an acute cardiac event had a greater risk of ICU admission (ARR, 1.54; 95% CI, 1.23-1.93), invasive mechanical ventilation (ARR, 2.00; 95% CI, 1.44-2.79), and in-hospital death (ARR, 1.77; 95% CI, 1.36-2.31) relative to those who did not experience an acute cardiac event (Table 5). The risk of severe outcomes was higher across most acute cardiac event categories compared with patients who did not experience an acute cardiac event (Table 4 and Table 5).

Table 4. Severe Outcomes Among Hospitalized Adults Aged 50 Years or Older With RSV Infection Stratified by Acute Cardiac Event Category.

Outcome	Unweighted No.	Length of hospitalization, weighted median (IQR), d	ICU admission, unweighted No. (weighted %)	Length of ICU stay, weighted median (IQR), d	Patients, unweighted No. (weighted %)
Outcome	Unweighted No.	Length of hospitalization, weighted median (IQR), d	ICU admission, unweighted No. (weighted %)	Length of ICU stay, weighted median (IQR), d	With invasive mechanical ventilation	With in-hospital death
Overall	6248	4 (2-7)	1196 (18.6)	3 (1-7)	464 (6.8)	333 (4.9)
≥1 Acute cardiac event	1383	5 (3-9)	388 (25.8)	4 (1-8)	164 (10.4)	126 (8.1)
Acute heart failure	965	5 (3-10)	245 (23.8)	4 (1-9)	97 (9.0)	79 (7.3)
Acute ischemic heart disease	468	5 (3-9)	156 (29.5)	4 (1-8)	76 (14.2)	50 (9.2)
Hypertensive crisis	76	4 (2-7)	22 (27.3)	2 (1-4)^a	7 (6.8)	0
Ventricular tachycardia	73	6 (3-12)	25 (34.1)	4 (2-13)	12 (14.4)	12 (10.8)
Cardiogenic shock	40	8 (2-15)	37 (93.1)	5 (2-12)	26 (67.5)	24 (57.0)
Other acute heart disease^b	94	5 (3-9)	37 (38.6)	4 (2-7)	19 (19.2)	12 (12.1)
No acute cardiac event	4865	4 (2-7)	808 (16.5)	3 (1-7)	300 (5.8)	207 (4.0)

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Abbreviations: ICU, intensive care unit; RSV, respiratory syncytial virus.

^{^a}

Relative SE >0.3.

^{^b}

Includes stress cardiomyopathy, viral cardiomyopathy, myocarditis, pericarditis, and endocarditis.

Table 5. Acute Cardiac Events and Severe Outcomes Among Hospitalized Adults Aged 50 Years or Older With RSV Infection.

Outcome and event	Bivariate models		Multivariable models^a
Outcome and event	RR (95% CI)	P value	ARR (95% CI)	P value
ICU admission
≥1 Acute cardiac event	1.58 (1.24-2.03)	<.001	1.54 (1.23-1.93)	<.001
Acute heart failure	1.37 (1.04-1.81)	.02	1.25 (0.95-1.66)	.11
Acute ischemic heart disease	1.68 (1.41-2.01)	<.001	1.61 (1.41-1.85)	<.001
Ventricular tachycardia	1.84 (1.18-2.86)	.01	1.60 (1.18-2.17)	<.001
Other acute heart disease^b	2.14 (1.71-2.66)	<.001	1.98 (1.71-2.30)	<.001
Invasive mechanical ventilation
≥1 Acute cardiac event	2.00 (1.27-3.15)	<.001	2.00 (1.44-2.79)	<.001
Acute heart failure	1.56 (1.02-2.37)	.04	1.47 (1.08-2.00)	.01
Acute ischemic heart disease	2.58 (1.76-3.77)	<.001	2.28 (1.74-2.99)	<.001
In-hospital death
≥1 Acute cardiac event	2.07 (1.60-2.66)	<.001	1.77 (1.36-2.31)	<.001
Acute heart failure	1.67 (1.32-2.11)	<.001	1.29 (1.01-1.65)	.03
Acute ischemic heart disease	2.05 (1.56-2.70)	<.001	1.86 (1.46-2.37)	<.001

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Abbreviations: ARR, adjusted risk ratio; ICU, intensive care unit; RR, risk ratio; RSV, respiratory syncytial virus.

^{^a}

Models were adjusted for surveillance season, age group, sex, race and Hispanic ethnicity group, heart failure, atrial fibrillation, coronary artery disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cerebrovascular accident, severe obesity, and smoking status.

^{^b}

Includes stress cardiomyopathy, viral cardiomyopathy, myocarditis, pericarditis, and endocarditis.

Discussion

Based on data from more than 6200 laboratory-confirmed RSV-associated hospitalizations in 12 states, this study found that nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event—most frequently acute heart failure—during their hospitalization. Acute cardiac events occurred frequently among adults with a history of underlying cardiovascular disease, particularly chronic heart failure. However, acute cardiac events also occurred in 1 in 12 adults who had no previous documentation of cardiovascular disease, suggesting that severe RSV infection may precipitate or reveal previously undiagnosed cardiovascular disease. Another novel finding of this study was the identification of less common, but life-threatening events that may occur in the context of RSV infection, including ventricular tachycardia, hypertensive crisis, cardiogenic shock, and acute myocarditis. Hospitalized patients with RSV who experienced an acute cardiac event had almost twice the risk of severe outcomes compared with those who did not experience an acute cardiac event. Although acute cardiac events identified in this study cannot be definitively attributed to RSV infection, these findings suggest that acute cardiac events occur frequently among hospitalized older adults with RSV infection and are associated with greater illness severity.

Results from this study support previous findings that acute heart failure, coronary events, and atrial fibrillation occur frequently among adults hospitalized with acute respiratory infections, including influenza and SARS-CoV-2.^{18,19,20,21,22} Notably, we found that 14.5% of hospitalized adults aged 50 years or older with RSV infection experienced acute heart failure. This prevalence was higher than in similarly aged hospitalized adults with laboratory-confirmed influenza or COVID-19 infection (5.5% to 9.0% for influenza-associated hospitalizations and 4.0% to 8.5% for COVID-19–associated hospitalizations, depending on the age group)^18,19 and is consistent with prior studies indicating that adults with chronic heart failure are at increased risk of severe illness from RSV infection.^1,3 Acute ischemic heart disease occurred as often among hospitalized adults aged 50 years or older with RSV infection as among similarly aged hospitalized adults with laboratory-confirmed influenza or COVID-19 infection (4.1% to 9.0% for influenza-associated hospitalizations and 5.1% to 7.8% for COVID-associated hospitalizations, depending on the age group).^18,19 Although the pathophysiology by which respiratory viral infection could result in acute cardiac events has not been established, it may include both pathogen-specific and nonspecific mechanisms. Hypothesized mechanisms include increased cytokine-related inflammatory responses that contribute to coronary plaque destabilization, hypercoagulability resulting in an increased risk of thromboses, demand ischemia due to physiologic and metabolic stress from acute respiratory illness, direct myocardial injury, and indirect consequences from the strain on the respiratory tract, all of which may occur with RSV infection.²³

In 2023, the first 2 RSV vaccines in the US for use in adults aged 60 years or older were approved and recommended based on shared clinical decision-making.^11,16,17 Both vaccines were shown to be effective in preventing symptomatic RSV lower respiratory tract disease in older adults, but clinical trials were underpowered to estimate effectiveness against more severe disease, including disease requiring hospitalization.^34,35 Prevention of acute cardiac events may be another important consideration for postlicensure studies of the impact of RSV vaccines, especially among older adults with risk factors for such events identified in this study. Indeed, influenza vaccination has been associated with reduced risk of acute cardiovascular events in the hospital setting.^18,30 With additional candidate RSV vaccines in clinical trials³⁶ and potential expansion of RSV vaccination to adults aged 50 to 59 years,³¹ interest in this topic is likely to grow. This study demonstrates the prevaccine epidemiology of acute cardiac events among adults with RSV-associated hospitalization, which represents a substantial burden of potentially vaccine-preventable disease.

Strengths and Limitations

A strength of this analysis was its use of data from a large and geographically diverse population-based surveillance system. Limitations included an inability to causally attribute the observed acute cardiac events to the RSV infection given that the temporal order of RSV infection and acute cardiac events cannot be established. Additionally, as RSV-NET conducts surveillance of hospitalized patients with RSV, we lack the ability to compare the frequency of acute cardiac events with that in hospitalized older adults who do not have laboratory-confirmed RSV infection. Importantly, RSV-NET’s case ascertainment methods may be biased toward more severe cases of RSV infection, which might in turn be more likely to involve cardiovascular complications because not all adults with acute respiratory illness, particularly those with milder illness, are tested for RSV.¹⁵ Acute cardiac events may be underdetected because of ICD-9-CM or ICD-10-CM coding and collection limitations, and our definition of acute cardiac events excluded conditions that could not be confidently distinguished from chronic underlying conditions (eg, atrial fibrillation) on the basis of ICD-9-CM or ICD-10-CM codes.^18,19 The data necessary to clinically validate acute cardiac events (eg, based on laboratory test results, echocardiography, cardiac magnetic resonance imaging, or histology) or establish the temporal order of RSV infection, acute cardiac events occurrence, and severe outcomes are not collected in RSV-NET. Results from this study are not necessarily generalizable to the overall US population, other time periods, or younger age groups.

Conclusions

The results of this cross-sectional study over 5 RSV seasons suggest that acute cardiac events are prevalent among hospitalized adults aged 50 years or older who have laboratory-confirmed RSV infection, occurring in nearly one-quarter of hospitalizations. These events—most commonly acute heart failure—occurred most frequently in older age groups and among those with underlying cardiovascular disease. Notably, acute cardiac events were also identified in 1 of 12 patients with no previously documented cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. Acute cardiac events contribute substantially to the burden of RSV disease; whether RSV vaccination can prevent these complications is an important question as the impact of these vaccines is evaluated.

Supplement 1.

eTable 1. Summary of Surveillance Population by Surveillance Year

eTable 2. Comparison of Hospitalized Adults Aged 50 Years or Older With Laboratory-Confirmed RSV Infection by Inclusion Status

eTable 3. ICD-9-CM or ICD-10-CM Codes Used to Identify Acute Cardiac Events

eTable 4. Underlying Medical Condition Definitions

eTable 5. Characteristics of Hospitalized Adults Aged 50 Years or Older With Laboratory-Confirmed RSV Infection by Surveillance Season

eTable 6. Prevalence of Acute Cardiac Events, Acute Heart Failure, and Acute Ischemic Heart Disease Among Hospitalized Adults Aged 50 Years or Older With Laboratory-Confirmed RSV Infection

eTable 7. Risk Factors for Acute Cardiac Events Among Hospitalized Adults with RSV Infectione

eFigure. Study Sample Flowchart

jamainternmed-e240212-s001.pdf^{(310.9KB, pdf)}

Supplement 2.

Nonauthor Collaborators

jamainternmed-e240212-s002.pdf^{(120KB, pdf)}

Supplement 3.

Data Sharing Statement

jamainternmed-e240212-s003.pdf^{(14.4KB, pdf)}

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

eTable 1. Summary of Surveillance Population by Surveillance Year

eTable 2. Comparison of Hospitalized Adults Aged 50 Years or Older With Laboratory-Confirmed RSV Infection by Inclusion Status

eTable 3. ICD-9-CM or ICD-10-CM Codes Used to Identify Acute Cardiac Events

eTable 4. Underlying Medical Condition Definitions

eTable 5. Characteristics of Hospitalized Adults Aged 50 Years or Older With Laboratory-Confirmed RSV Infection by Surveillance Season

eTable 6. Prevalence of Acute Cardiac Events, Acute Heart Failure, and Acute Ischemic Heart Disease Among Hospitalized Adults Aged 50 Years or Older With Laboratory-Confirmed RSV Infection

eTable 7. Risk Factors for Acute Cardiac Events Among Hospitalized Adults with RSV Infectione

eFigure. Study Sample Flowchart

jamainternmed-e240212-s001.pdf^{(310.9KB, pdf)}

Supplement 2.

Nonauthor Collaborators

jamainternmed-e240212-s002.pdf^{(120KB, pdf)}

Supplement 3.

Data Sharing Statement

jamainternmed-e240212-s003.pdf^{(14.4KB, pdf)}

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PERMALINK

Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

Rebecca C Woodruff, PhD, MPH

Michael Melgar, MD

Huong Pham, MPH

Laurence S Sperling, MD

Fleetwood Loustalot, PhD

Pam Daily Kirley, MPH

Elizabeth Austin, MPH

Kimberly Yousey-Hindes, MPH

Kyle P Openo, DrPH

Patricia Ryan, MS

Chloe Brown, MPH

Ruth Lynfield, MD

Sarah Shrum Davis, MPH

Grant Barney, MPH

Brenda Tesini, MD

Melissa Sutton, MD, MPH

H Keipp Talbot, MD, MPH

Hafsa Zahid, MPH

Lindsay Kim, MD

Fiona P Havers, MD

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Design, Setting, and Participants

Exposures

Main Outcomes and Measures

Results

Conclusions and Relevance

Introduction

Methods

Participants and Procedures

Demographic Characteristics

Clinical Characteristics and Severe Outcomes

Statistical Analysis

Results

Table 1. Characteristics of Hospitalized Adults With RSV Infection by Acute Cardiac Event Status.

Period Prevalence of Acute Cardiac Events

Table 2. Period Prevalence of Acute Cardiac Events Among Hospitalized Adults With RSV Infection.

Table 3. Risk Factors for Acute Cardiac Events, Acute Heart Failure, and Acute Ischemic Heart Disease Among Hospitalized Adults With RSV Infectiona.

Risk Factors for Acute Cardiac Events

Acute Cardiac Events and Severe Outcomes

Table 4. Severe Outcomes Among Hospitalized Adults Aged 50 Years or Older With RSV Infection Stratified by Acute Cardiac Event Category.

Table 5. Acute Cardiac Events and Severe Outcomes Among Hospitalized Adults Aged 50 Years or Older With RSV Infection.

Discussion

Strengths and Limitations

Conclusions

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

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Cited by other articles

Links to NCBI Databases

Table 3. Risk Factors for Acute Cardiac Events, Acute Heart Failure, and Acute Ischemic Heart Disease Among Hospitalized Adults With RSV Infection^a.