Low Vaccination Coverage Rates Among Persons With Cardiovascular Disease (CVD)
The American Heart Association (AHA) American College of Cardiology (ACC) recommend that the >12 million persons in the United States with cardiovascular conditions get annual influenza vaccination. Current influenza vaccination coverage among persons with heart disease is far below national coverage goals set in Healthy People 2010 (>60% for persons <65 years of age; >90% for persons >65 years of age): Only 1 in every 3 adults with heart disease (34%) received influenza vaccination in 2005, a level of coverage that is essentially unchanged from other below-target rates achieved in 2002. In 2005, vaccination coverage among older adults (>65 years old) with heart disease was much higher (71%) than among middle-aged (50 to 64 years old) and younger (18 to 49 years old) adults with heart disease (41% and 23%, respectively). Non-Hispanic white adults had similar influenza vaccination rates (38%) to black adults (36%), but rates in both groups were higher than among Hispanic adults (30%).
Failure to vaccinate persons with cardiovascular conditions and disparities in vaccination coverage across age categories and ethnic groups represent major opportunities for healthcare providers to improve the care of this patient population. A central barrier to vaccination against influenza is that only about one half of cardiology practices nationwide stock influenza vaccine, as opposed to >70% of endocrinology practices and of generalist primary care practices and >90% of pulmonology practices.
Outpatient visits to cardiology practices present a superb but frequently missed opportunity to administer influenza vaccine to millions of adults with CVD, as do outpatient visits in primary care settings and hospitalizations for cardiovascular causes. A recent study suggests that the most effective ways to improve influenza vaccination rates among nonelderly adults with heart disease are for cardiology practices to have influenza vaccine available in their offices for patient visits, for cardiovascular care providers to strongly recommend vaccination to their patients during vaccination season, and for practices to implement standing-orders protocols that permit staff to administer influenza vaccine to patients with cardiovascular indications without waiting in each case for a physician's order.
It is important to emphasize that strong recommendations from health professionals about vaccination against influenza can be very influential, especially for urban, predominantly black patients. Patient-level barriers to influenza vaccination, specifically for persons with CVD, have not been well characterized and should be examined in future research.
Providers and practices that provide care for patients with CVD should stock influenza vaccine annually. There is a choice of manufacturers, and the vaccines are considered equally effective. Ordering information for all manufacturers licensed to provide influenza vaccine in the United States for the 2006/2007 season is provided on the American Heart Association Web site (www.americanheart.org) and in the Table.
Table. How Providers Can Place an Order for Influenza Vaccine in the United States
Influenza Vaccine Manufacturers*
(Alphabetical Order)
|
How to Order for the 2006/2007 Influenza Season+,++ |
GlaxoSmithKline |
Call Fluarix Service Center at 1-866-475-8222 (choose option 1). |
Novartis (formerly Chiron) |
Call 1-800-244-7668 (choose option 2) to receive a list of vaccine distributors in your area. |
Sanofi Pasteur |
Set up a provider account and then place order at http://www.vaccineshoppe.com. |
*These are manufacturers of inactivated trivalent influenza vaccine. Live, attenuated intranasal influenza vaccine (FluMist;MedImmune) is not recommended for individuals with cardiovascular conditions.
+Providers are encouraged to order vaccine in the spring and summer for delivery in the fall before each influenza season.
++Providers who wish to have more information about influenza vaccine should contact their local or state public health departments.