H1N1 Flu and Patients With Cardiovascular Disease (Heart Disease and Stroke):

Interim Guidance and Considerations for Health Care Providers and for State and Local Public Health Agencies

May 2, 2009 10:32 PM ET

Patients should see Interim Guidance for People With Heart Disease, Stroke, or Cardiovascular Disease.

• Patients with chronic cardiovascular disease and cerebrovascular disease (CVD) are at increased risk of experiencing an acute exacerbation of disease during influenza epidemics. (1-7)
• Patients with CVD risk factors such as hypertension, smoking, obesity, and family history of premature heart disease might be considered for priority care over healthy individuals but not before health care providers, the very young, elderly people, and the ill. (8)
• Health care providers should be aware that influenza might produce increased numbers of cardiovascular events, leading to increased hospitalizations and use of resources to treat acute coronary events, heart failure, and stroke. (9-11)
• Consideration should be given for having adequate supplies of commonly used cardiovascular medications for prevention and treatment of cardiovascular events. (8)

References

1. Madjid M, Naghavi M, Litovsky S, Casscells SW. Influenza and cardiovascular disease: a new opportunity for prevention and the need for further studies. Circulation 2003;108:2730–6.
2. Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003;348(14):1322–32.
3. Gurfinkel EP, de la Fuente RL, Mendiz O, Mautner B. Influenza vaccine pilot study in acute coronary syndromes and planned percutaneous coronary interventions: the FLU Vaccination Acute Coronary Syndromes (FLUVACS) Study. Circulation 2002;105(18):2143–7.
4. Ciszewski A, Bilinska ZT, Brydak LB, et al. Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. Eur Heart J 2008;29(11):1350–8.
5. Lavallee P, Perchaud V, Gautier-Bertrand M, Grabli D, Amarenco P. Association between influenza vaccination and reduced risk of brain infarction. Stroke 2002;33(2):513–8.
6. Madjid M, Aboshady I, Awan I, Litovsky S, Casscells SW. Influenza and cardiovascular disease: is there a causal relationship? Tex Heart Inst J 2004;31:4–13.
7. Madjid M, Curkendall S, Blumentals WA. The influence of oseltamivir treatment on the risk of stroke after influenza infection. Cardiology 2008 Nov 15;113(2):98–107. [Epub ahead of print]
8. Madjid M, Casscells SW. Of birds and men: cardiologists' role in influenza pandemics. Lancet 2004;364(9442):1309.
9. Mensah GA, Grant AO, Pepine CJ, et al. ACCF/AHA/CDC conference report on emerging infectious diseases and biological terrorism threats: the clinical and public health implications for the prevention and control of cardiovascular diseases. J Am Coll Cardiol 2007;49(12):1373–1412.
10. Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004;351(25):2611–8.
11. Madjid M, Miller CC, Zarubaev VV, et al. Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34,892 subjects. Eur Heart J 2007;28(10):1205–10.