More Than 1 in 3 Adults With Heart Disease Still Skip the Flu Shot, And Disparities Are Driving the Gap

For patients living with atherosclerotic cardiovascular disease (ASCVD), influenza is far more than a seasonal inconvenience. Findings from a study published in the New England Journal of Medicine demonstrated a 6-fold increased risk of myocardial infarction (MI) within 7 days of confirmed influenza infection, and data from a population-based study of adults hospitalized with influenza showed that nearly 12% experienced an acute cardiovascular event. Given this risk, the American College of Cardiology and American Heart Association guidelines recommend influenza vaccination for patients with ASCVD to reduce the risk of cardiovascular morbidity and mortality.^1-3

Data from a 2023 meta-analysis of more than 9000 patients revealed that individuals who received the influenza vaccine had a notable reduction in major cardiovascular events, with 517 cases compared with 621 in the placebo group, along with decreased rates of MI and cardiovascular death. A separate analysis confirmed that influenza vaccination was associated with a 25% and 18% relative risk reduction in all-cause and cardiovascular mortality, respectively, in patients with CVD.^2,4

A 20-Year Look at the Vaccination Gap

Using 20 years of serial cross-sectional data from the National Health Interview Survey, Reed Mszar, MPH, MS, lead study author and PhD candidate in the Department of Chronic Disease Epidemiology at Yale School of Public Health, and colleagues analyzed 56,551 adults with ASCVD, including those with prior MI, stroke, angina, or coronary heart disease, to track influenza vaccination trends from 2005 to 2024.¹

Although vaccination rates improved by 9.5% over the study period (from 50.8% to 60.3%), approximately 39.1% of adults with ASCVD, representing roughly 7.5 million individuals annually, still lacked influenza vaccination in any given year. Even after 2 decades of public health efforts, more than 1 in 3 high-risk patients are going unvaccinated each flu season.¹

Persistent and Measurable Disparities

The study's most striking findings involve the populations left furthest behind. After multivariable adjustment, the odds of lacking influenza vaccination were significantly elevated among non-Hispanic Black individuals (adjusted OR [aOR], 1.27), those with lower education (aOR, 1.16), low income (aOR, 1.24), no insurance (aOR, 2.38), non–US-born immigrant status (aOR, 1.25), and those without a usual source of care (aOR, 2.74).¹

By 2024, the highest proportions of unvaccinated individuals were adults aged 45 to 54 years (65.0%), those without insurance coverage (73.0%), and those without a usual source of care (73.5%). These figures are consistent with broader patterns identified in the literature. According to the CDC, only about 40% of adults in rural areas receive influenza vaccinations, compared with 48% of those in urban and suburban areas, and this gap continues to grow.^1,5

Vaccine equity barriers extend beyond geography. For many patients, getting vaccinated means navigating challenges such as a lack of transportation to a vaccination site, limited internet access for scheduling appointments, or the distance to the nearest pharmacy.⁵

Pharmacist Opportunity

Community pharmacists are increasingly recognized as essential partners in closing this gap. A pharmacist-managed influenza vaccination program in a secondary prevention lipid clinic increased vaccination rates from 39% to 76%, and notably eliminated preexisting age-related disparities in vaccination rates after program implementation.⁶

Pharmacists’ presence in rural and underserved areas positions them to reach individuals with limited access to health care services, and educating patients at every visit creates opportunities to recommend vaccination and explain how it helps prevent serious illness.⁵

A Call to Action for the Pharmacy Community

The findings serve as both a progress report and an urgent call to action. Although modest gains have been made, millions of patients with ASCVD, disproportionately those who are uninsured, lower-income, or without a regular care provider, remain unprotected each flu season. Major society guidelines strongly recommend influenza vaccination for patients with established CVD, yet the vaccine remains underutilized.³

Pharmacists are well equipped to act. From proactive counseling and standing order protocols to targeted outreach in underserved communities, the profession has demonstrated it can move the needle. Ensuring that the flu shot reaches every patient with heart disease, regardless of income or insurance status, is not only a public health imperative but a cardiovascular one.

REFERENCES

1. Mszar R, Katz ME, Grandhi G, et al. Trends and disparities in influenza vaccination among adults with atherosclerotic cardiovascular disease in the United States, 2005–2024. Presented at: American Heart Association EPI|Lifestyle Scientific Sessions 2026; March 18, 2026; Boston, MA.

2. Yedlapati SH, Khan SU, Talluri S, et al. Effects of influenza vaccine on mortality and cardiovascular outcomes in patients with cardiovascular disease: a systematic review and meta-analysis. J Am Heart Assoc. 2021;10(6):e019636. doi:10.1161/JAHA.120.019636

3. Lim KH, Park JS. Persistent gaps in influenza vaccination rates among patients with elevated atherosclerotic cardiovascular disease risk. Korean Circ J. 2025;55(7):637-639. doi:10.4070/kcj.2025.0124

4. Omidi F, Zangiabadian M, Shahidi Bonjar AH, Nasiri MJ, Sarmastzadeh T. Influenza vaccination and major cardiovascular risk: a systematic review and meta-analysis of clinical trials studies. Sci Rep. 2023;13(1):20235. doi:10.1038/s41598-023-47690-9

5. Fournier T. Under the weather: unpacking the impact of the 2024-2025 influenza season. Pharmacy Times. July 21, 2025. Accessed March 31, 2026. https://www.pharmacytimes.com/view/under-the-weather-unpacking-the-impact-of-the-2024-2025-influenza-season

6. Loughlin SM, Mortazavi A, Garey KW, Rice GK, Birtcher KK. Pharmacist-managed vaccination program increased influenza vaccination rates in cardiovascular patients enrolled in a secondary prevention lipid clinic. Pharmacotherapy. 2007;27(5):729-733. doi:10.1592/phco.27.5.729