Introduction
Heart failure (HF) is a clinical syndrome caused by malfunction of the
heart’s ability to pump blood to the rest of the body due to impaired
ventricular filling or ejection. Clinical manifestations encompass a
large constellation of signs and symptoms of volume overload. HF affects
over 6 million Americans(1) and costing the
healthcare system up to 32 billion dollars
annually(2). When unmanaged, it can be
debilitating, rapidly progressive and ultimately fatal.
Throughout decades of research, the scientific community has identified
various etiologies of HF that range from common conditions such as
coronary artery disease and valvular diseases, to less common conditions
such as infections(3,
4). Several studies have repeatedly shown
that influenza infection represent a significant hazard for patients
with heart failure. Sepsis was shown to increase hospitalization of
heart failure and mortality. More recently amidst the COVID-19 pandemic,
there have been reports of increased incidence of heart failure in
patients with acute COVID-19 infection(5).
Based on the role of infections on heart failure, it was reasonable to
hypothesize that vaccines may curb the deleterious effects of infections
on heart failure. Indeed, several studies have demonstrated a
cardioprotective of annual influenza
vaccine(6,
7). Influenza vaccination reduced
all-cause mortality in patients enrolled on
PARADIGM-HF(8). Additionally, pneumococcal
vaccination was associated with lower heart failure incidence and
all-cause mortality(9). Based on these
studies, the 2022 American College of Cardiology/American Heart
Association/ Heart Failure Society of America HF guidelines encouraged
vaccination for heart failure
patients(10).
Whereas the previous strongly showed a positive impact of vaccination on
heart failure, a comprehensive evaluation of the role of vaccination in
heart failure is lacking especially with the evolving techniques and
types of vaccines, such as mRNA vaccines. For example, previous case
reports described an association between Takotsubo (stress)
cardiomyopathy and COVID-19 vaccine(11).
Therefore, we decided to analyze VAERS database to provide the first
comprehensive evaluation of the association between vaccines and
cardiomyopathy/heart failure.