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INFLUENZA VACCINATION FOR SECONDARY CARDIOVASCULAR PREVENTION: A SYSTEMATIC REVIEW
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082 INFLUENZA VACCINATION FOR SECONDARY CARDIOVASCULAR PREVENTION: A SYSTEMATIC REVIEW M LeBras, A Barry Vancouver, British Columbia BACKGROUND:
Influenza is a common respiratory infection that can result in multiple complications including CV events. Influenza illness increases the risk of myocardial infarction 2fold with the highest risk among patients with established CVD. The mechanism by which influenza may cause CV events is unclear, but may be related to triggering rupture of vulnerable atherosclerotic plaques. Other contributing factors may involve impaired HDL-C anti-inflammatory properties by increased macrophage infiltration, or the sequelae of acute infection (e.g., fever, tachycardia, dehydration). The influenza vaccine has been associated with reductions in myocardial infarction, cerebrovascular disease, and death, likely by reducing the risk of influenza infection. The purpose of this systematic review was to evaluate the evidence for influenza vaccination as a strategy to reduce CV events in patients with established CVD. METHODS: Medline, Embase, and Cochrane Central Register of Controlled Trials were queried from inception to February 2016 using the terms influenza vaccine and cardiovascular disease. The search was limited to human studies published in English. Included were randomized controlled trials (RCTs), matched non-randomized studies, and meta-analyses that compared influenza vaccination to control (placebo or no intervention) in patients with established CVD and reported clinically meaningful CV outcomes (CV death, myocardial infarction, or stroke). The quality of the included studies were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS: The search yielded 456 citations, and 10 studies were included (2 meta-analyses, 5 RCTs, and 3 non-randomized trials). Data from randomized and non-randomized studies demonstrated inconsistent results with respect
Canadian Journal of Cardiology Volume 32 2016
to CV death and major adverse cardiovascular events (MACE) due to small sample sizes and low event rates. However, meta-analyses of RCTs demonstrated that the influenza vaccine, compared to control, reduced CV death in patients with established CVD by approximately 50%. Influenza vaccination also reduced MACE by approximately 43%, which was even higher (54%) in the subgroup of patients with a recent acute coronary syndrome. Adverse events were not consistently reported, though most were minor and transient. CONCLUSION: Influenza vaccination is an effective strategy for reducing CV events in patients with pre-existing CVD. Data from individual studies demonstrated inconsistent results; however, when combined in a meta-analysis, the influenza vaccine, as compared to control, reduced both CV death and MACE by approximately 50%. Based on these data, the annual influenza vaccine should be emphatically recommended for all patients with established CVD.
Canadian Society of Cardiac Surgeons (CSCS) Highlighted ePoster HIGHLIGHTED RESEARCH IN SURGERY Saturday, October 22, 2016 083 SUBTLE DEGREES OF FRAILTY RESULT IN ADVERSE CARDIAC SURGERY OUTCOMES EJ Wilson-Pease, G Kephart, R Gainer, J Begum, G Hirsch Halifax, Nova Scotia BACKGROUND:
In North America, octogenarians are the fastest growing demographic. Chronological age of a patient is not always the same as their biological age, and their biological status can vary from robust to frail. Frail patients are predisposed to falls, institutionalization, hospitalization, and mortality. In the realm of cardiac surgery, there is little research examining frailty as a risk factor for cardiac surgical intervention. PURPOSE: The objective of the current study is to explore the relationship between more subtle degrees of frailty and cardiac surgical outcomes in more detail. METHODS: This non-interventional study subjects all consented participants fitting inclusion criteria to the same questionnaires. The assessment is comprised of the Frailty Assessment for Care-Planning Tool (FACT) for both patient and their collateral, and the EQ-5D-3L. A similar interview process is repeated 5-7 months after surgery, with the addition of a qualitative interview. RESULTS: Pilot study results (n¼57) show that 52% of the participants were positive for at least one category of frailty at a level of 4/7 (vulnerable). Results also demonstrated that 3.8% of participants who scored zero deficits on the FACT were discharged to an institution for follow up care compared to 19.3% of participants with one or more deficits.
082 INFLUENZA VACCINATION FOR SECONDARY CARDIOVASCULAR PREVENTION: A SYSTEMATIC REVIEW M LeBras, A Barry Vancouver, British Columbia BACKGROUND:
Influenza is a common respiratory infection that can result in multiple complications including CV events. Influenza illness increases the risk of myocardial infarction 2fold with the highest risk among patients with established CVD. The mechanism by which influenza may cause CV events is unclear, but may be related to triggering rupture of vulnerable atherosclerotic plaques. Other contributing factors may involve impaired HDL-C anti-inflammatory properties by increased macrophage infiltration, or the sequelae of acute infection (e.g., fever, tachycardia, dehydration). The influenza vaccine has been associated with reductions in myocardial infarction, cerebrovascular disease, and death, likely by reducing the risk of influenza infection. The purpose of this systematic review was to evaluate the evidence for influenza vaccination as a strategy to reduce CV events in patients with established CVD. METHODS: Medline, Embase, and Cochrane Central Register of Controlled Trials were queried from inception to February 2016 using the terms influenza vaccine and cardiovascular disease. The search was limited to human studies published in English. Included were randomized controlled trials (RCTs), matched non-randomized studies, and meta-analyses that compared influenza vaccination to control (placebo or no intervention) in patients with established CVD and reported clinically meaningful CV outcomes (CV death, myocardial infarction, or stroke). The quality of the included studies were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS: The search yielded 456 citations, and 10 studies were included (2 meta-analyses, 5 RCTs, and 3 non-randomized trials). Data from randomized and non-randomized studies demonstrated inconsistent results with respect
Canadian Journal of Cardiology Volume 32 2016
to CV death and major adverse cardiovascular events (MACE) due to small sample sizes and low event rates. However, meta-analyses of RCTs demonstrated that the influenza vaccine, compared to control, reduced CV death in patients with established CVD by approximately 50%. Influenza vaccination also reduced MACE by approximately 43%, which was even higher (54%) in the subgroup of patients with a recent acute coronary syndrome. Adverse events were not consistently reported, though most were minor and transient. CONCLUSION: Influenza vaccination is an effective strategy for reducing CV events in patients with pre-existing CVD. Data from individual studies demonstrated inconsistent results; however, when combined in a meta-analysis, the influenza vaccine, as compared to control, reduced both CV death and MACE by approximately 50%. Based on these data, the annual influenza vaccine should be emphatically recommended for all patients with established CVD.
Canadian Society of Cardiac Surgeons (CSCS) Highlighted ePoster HIGHLIGHTED RESEARCH IN SURGERY Saturday, October 22, 2016 083 SUBTLE DEGREES OF FRAILTY RESULT IN ADVERSE CARDIAC SURGERY OUTCOMES EJ Wilson-Pease, G Kephart, R Gainer, J Begum, G Hirsch Halifax, Nova Scotia BACKGROUND:
In North America, octogenarians are the fastest growing demographic. Chronological age of a patient is not always the same as their biological age, and their biological status can vary from robust to frail. Frail patients are predisposed to falls, institutionalization, hospitalization, and mortality. In the realm of cardiac surgery, there is little research examining frailty as a risk factor for cardiac surgical intervention. PURPOSE: The objective of the current study is to explore the relationship between more subtle degrees of frailty and cardiac surgical outcomes in more detail. METHODS: This non-interventional study subjects all consented participants fitting inclusion criteria to the same questionnaires. The assessment is comprised of the Frailty Assessment for Care-Planning Tool (FACT) for both patient and their collateral, and the EQ-5D-3L. A similar interview process is repeated 5-7 months after surgery, with the addition of a qualitative interview. RESULTS: Pilot study results (n¼57) show that 52% of the participants were positive for at least one category of frailty at a level of 4/7 (vulnerable). Results also demonstrated that 3.8% of participants who scored zero deficits on the FACT were discharged to an institution for follow up care compared to 19.3% of participants with one or more deficits.