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Nearly a quarter of patients with RSV experience an acute cardiac event, including life-threatening conditions such as cardiogenic shock and acute myocarditis.

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“Respiratory viral diseases, including influenza and COVID-19, have been associated with acute cardiovascular disease and mortality through ecological analyses and hospital-based surveillance,” Rebecca C. Woodruff, PhD, MPH, and colleagues wrote in JAMA Internal Medicine. “Emerging evidence raises concerns about acute cardiac events as potential complications of RSV infection as well, especially among older adults.”

It is estimated that cardiac complications occur in 14% to 22% of older adults hospitalized with RSV and can include heart failure exacerbation, acute coronary syndrome, and arrhythmias, according to the researchers. However, Dr. Woodruff and colleagues noted that these estimates are based mainly on single-center studies with limited sample sizes and did not examine risk factors for experiencing an acute cardiac event or the severity of the event.

More complete data on the potential cardiac complications of RSV infection, they continued, would inform clinical and public health guidelines, allow for the characterization of RSV-associated cardiovascular disease before the approval of RSV vaccines, and spur studies that examine the prevention of acute cardiac events through RSV vaccination.

Dr. Woodruff and colleagues conducted a cross-sectional study using data from the RSV Hospitalization Surveillance Network. They examined cardiac events among adults aged 50 or older with RSV over 5 seasons: annually from 2014-2015 through 2017-2018 and 2022-2023.

Cardiac Events Common in Those With RSV

The analysis included 6,248 adults hospitalized with RSV (median age, 72.7; 59.6% women). More than half of the patients (56.4%) had underlying cardiovascular disease. Other underlying conditions included diabetes (35.0%), COPD (34.2%), and chronic kidney disease (28.5%).

The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0% to 23.7%). Weighted estimated prevalence rates for specific cardiac events included:

• Acute heart failure: 15.8% (95% CI, 14.6% to 17.0%)
• Acute ischemic heart disease: 7.5% (95% CI, 6.8% to 8.3%)
• Hypertensive crisis: 1.3% (95% CI, 1.0% to 1.7%)
• Ventricular tachycardia: 1.1% (95% CI, 0.8% to 1.4%)
• Cardiogenic shock: 0.6% (95% CI, 0.4% to 0.8%)

The risk for an acute cardiac event was higher among adults who had underlying cardiovascular disease compared with patients who did not (33.0% vs 8.5%).

Approximately a fifth of all patients (18.6%) required ICU admission; 4.9% died during hospitalization. The risks for ICU admission (25.8% vs 16.5%) and in-hospital death (8.1% vs 4.0%) were higher among patients who had an acute cardiac event versus those who did not (Table).

Future Research & The Potential Impact of Vaccines

Importantly, the researchers identified acute cardiac events among 1 in 12 adults with RSV and no history of cardiovascular disease, which suggests that “severe RSV infection may precipitate or reveal previously undiagnosed cardiovascular disease.”

The study also reported “less common, but life threatening, events” among patients with RSV, including ventricular tachycardia, hypertensive crisis, cardiogenic shock, and acute myocarditis.

“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,” Dr. Woodruff and colleagues wrote.

Looking forward, the researchers noted that the prevention of acute cardiac events “may be another important consideration for post-license studies of the impact of RSV vaccines,” particularly among older adults with risk factors for such events.

“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,” Dr. Woodruff and colleagues wrote. “Whether RSV vaccination can prevent these complications is an important question as the impact of these vaccines is evaluated.”