Key Point

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

Investigation result
In this cross-sectional study of 6,248 adults hospitalized with RSV infection, 22% of patients experienced acute heart disease, most commonly acute heart failure (16%). Acute cardiac events occurred more frequently in people with underlying cardiovascular disease (33%) versus those without (9%) and were associated with nearly twice the risk of severe outcomes.

meaning
The results of this study suggest that acute cardiac events are common in older adults hospitalized with RSV infection and are associated with severe clinical outcomes.

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

objective
To describe the prevalence and severity of in-hospital acute cardiac events in adults aged 50 years and older with RSV infection.

Design/Setting/Participants
In this cross-sectional study, we analyzed surveillance data from the RSV Inpatient Surveillance Network, which abstracts detailed medical records of hospitalized patients with RSV infection detected by clinician-directed laboratory testing. We tested RSV infection cases among adults aged 50 years and older within 12 states across five RSV seasons (2014-2015, 2017-2018 and annually from 2022-2023) to determine weighted period prevalence and acute We estimated the 95% CI for cardiac events.

exposure
Acute cardiac events are identified as: International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, 10th Edition, Clinical Revision Review of discharge codes and discharge summaries.

Main results and measures
Severe disease outcomes such as intensive care unit (ICU) admission, invasive mechanical ventilation, and in-hospital mortality. Adjusted risk ratios (ARRs) were calculated to compare severe outcomes in patients with and without acute cardiac events.

result
The study included 6,248 hospitalized adults (median) [IQR] Age, 72.7 years old [63.0-82.3] Year. 59.6% are women. 56.4% had underlying cardiovascular disease and laboratory-confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0% to 23.7%). Weighted prevalence estimates were 15.8% (95% CI, 14.6% to 17.0%) for acute heart failure, 7.5% (95% CI, 6.8% to 8.3%), and 1.3% (95% CI) for acute ischemic heart disease. , 1.0). % to 1.7% for hypertensive crisis), 1.1% (95% CI, 0.8% to 1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4% to 0.8%) for cardiogenic shock. . Adults with underlying cardiovascular disease had an increased risk of experiencing acute cardiac events compared to adults without (33.0% vs 8.5%, ARR, 3.51, 95% CI, 2.85-4.32). Among adults hospitalized with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared to patients without an acute cardiac event, patients who experienced an acute cardiac event had an increased risk of ICU admission (25.8% vs. 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1%). it was high. vs. 4.0%; ARR, 1.77; 95% CI, 1.36-2.31).

Conclusion and relevance
This cross-sectional study spanning five seasons of Rvirus infection found that nearly one quarter of adults aged 50 years and older hospitalized with Rvirus infection experienced acute heart disease, most commonly acute heart failure. Among them, 1 in 12 adults (8.5%) were found to have no symptoms. Underlying cardiovascular disease is documented. The risk of a severe outcome was almost twice as high in patients who experienced an acute cardiac event compared to those who did not experience an acute cardiac event. These findings reveal the baseline epidemiology of potential cardiac complications from her RSV infection before the RSV vaccine was available.