Pneumococcal Vaccination is Underutilized in Adults With High Cardiovascular Risk

Over the last decade, pharmacists have significantly increased their capacity to facilitate and administer vaccinations. This is as vaccine hesitancy continues to rise across the country, necessitating novel avenues to better utilize immunization services and increase vaccination coverage for serious respiratory diseases, including pneumococcal disease and influenza.¹

Vaccinations to protect against vaccine-preventable respiratory diseases can help moderate cardiovascular risk. Evidence has underscored the correlation between infections and an elevated risk of cardiovascular and cerebrovascular events, ultimately increasing all-cause mortality. Such infections can contribute to the complex mechanisms that can heighten cardiovascular risk, cause new cardiac events, or exacerbate preexisting conditions.

In their roles as trusted health care professionals, pharmacists can positively contribute to increasing uptake among this high-risk population.¹

Past reviews have highlighted the impact pharmacists can have on vaccination uptake in a variety of settings. One systematic review found that pharmacist contributions to immunization programs encompassing pneumococcal, influenza, herpes zoster, and pertussis vaccines were indispensable. Across multiple studies, pharmacists demonstrated advocacy and leadership in both community and hospital settings. Given cardiovascular disease’s status as a leading killer worldwide, it is pertinent to evaluate how pharmacists and other providers can bridge gaps in respiratory vaccination in patients at high-risk.²

Investigators presenting at the European Society of Cardiology 2025 Congress in Madrid, Spain, showcased an abstract that aimed to uncover ways to increase vaccination rates among hospitalized adults with cardiovascular disease, while assessing the association between a patient’s awareness of the vaccines’ cardiovascular benefits and their likelihood of receiving said vaccines. In Argentina, pneumococcal and influenza vaccines are provided with no charge to individuals with cardiovascular disease, making the country an ideal setting for this investigation.³

The prospective, multicenter registry was conducted across 30 Argentinian cardiology centers between April 2023 and October 2024. Patients hospitalized with cardiovascular disease either as a scheduled admission or emergency were included in the trial. In total, 2937 patients (33.5% women, mean age of 69.2 years) were included. Among the cohort, 63.8% of patients were admitted because of an emergency or decompensation of their underlying condition, while 46.2% were classified as admitted due to secondary prevention.³

Missed Vaccination Opportunities

A large portion—97.2%—of participants had a formal indication for vaccination. Concerningly, only 49.9% of these patients had received a pneumococcal vaccine in the past year, and 51.7% had received an influenza vaccine; only 39.4% of these patients had received both vaccines. Compared with the COVID-19, 96.7% of the cohort received at least 1 dose, while 84.2% had received 3 or more doses. This disparity highlights the large gaps in pneumococcal and influenza coverage among high-risk cardiovascular patients and the failure of health care providers to adequately counsel and market the vaccines to patients as compared with the more well-known COVID-19 vaccine.³

For patients who were unvaccinated but had a formal indication for vaccination, 74.8% had attended at least 1 outpatient consultation in the past year, with 60.8% of the cohort visiting with a cardiologist and 41.9% consulting with a general practitioner. It is in this area that pharmacists can use their unique capabilities to fill gaps in vaccination. Harboring a specific expertise in pharmacotherapy and pharmacovigilance, pharmacists can help counsel patients towards receiving a vaccine by offering guidance, dispelling myths, and providing educational resources. If a vaccine is not administered in a cardiologist setting during a standard follow-up, pharmacists can step up and provide the vaccination themselves in regions where they are able.³

Educated Patients More Likely to Receive Pneumococcal Vaccination

To assess their views towards vaccination, the authors asked patients to rate the perceived usefulness of pneumococcal and influenza vaccines in preventing cardiovascular events on a scale of 1 to 10. For pneumococcal vaccination, the mean score was 4.4, while for influenza, the mean score was 4.6. Accordingly, only 13.1% and 13.9% of the patients, respectively, rated the vaccines as “highly beneficial,” correlating to a score of 9 or 10 points. The patients who perceived the vaccines having the most benefit also demonstrated higher vaccination rates.³

These data showcase that much work remains in properly utilizing immunization as a preventive strategy in high-risk cardiovascular adults. Pneumococcal disease can attack the respiratory system and cause long-term complications while exacerbating underlying cardiovascular conditions. This multicenter investigation shows that, when patients are properly educated on the benefits of pneumococcal vaccination, they are more likely to receive the vaccine. Pharmacists can help increase vaccination rates by providing such education and reinforcing the role of pneumococcal vaccination in preventing cardiovascular events, which is an often-overlooked benefit.³

REFERENCES

1. García-Zamora S, Pulido L. Vaccines in cardiology, an underutilized strategy to reduce the residual cardiovascular risk. Arch Peru Cardiol Cir Cardiovasc. 2024;5(1):29-39. doi:10.47487/apcyccv.v5i1.349

2. Rahim MHA, Dom SHM, Hamzah MSR, et al. Impact of pharmacist interventions on immunisation uptake: a systematic review and meta-analysis. J Pharm Policy Pract. 2023;17(1):2285955. doi:10.1080/20523211.2023.2285955

3. García-Zamora S, Balsano F, Ayon M, et al. Influenza and pneumococcal vaccination in high cardiovascular risk patients: a missed opportunity for prevention? Presented: European Society of Cardiology 2025 Congress; Madrid, Spain; September 1, 2025. Accessed Online: https://esc365.escardio.org/esc-congress/abstract?text=pneumococcal&docType=All&days&page=1&vue=cards