Study Reveals Impact of RSV on the Heart

Respiratory viral infections (RVIs) are known to increase cardiovascular risk, yet the specific cardiac complications associated with respiratory syncytial virus (RSV) compared with other common vaccine-preventable RVIs like COVID-19 or influenza have remained unclear. New study findings published by investigators in JAMA reveal a significant association between RSV hospitalization and a heightened risk of acute cardiovascular events, particularly when compared with boosted and upboosted COVID-19 cases, highlighting the underrecognized cardiac burden of RSV.¹

Image credit: Artur | stock.adobe.com

RSV and Heart Health

Despite RSV's significant disease burden in older adults, less is understood about cardiac complications specifically following RSV infection. According to the American Heart Association, around 14% to 22% of hospitalizations for adult individuals are complicated by cardiovascular issues. This includes worsening heart failure, acute myocardial infarction (AMI), arrhythmias, and stroke. Additionally, underlying cardiovascular disease has also been linked to 45% to 63% of adult hospitalizations for RSV. Specifically, adults with pre-existing congestive heart failure (CHF) are particularly vulnerable to RSV, experiencing an eightfold increase in hospitalization rates compared with those without CHF. While high rates of underlying coronary artery disease (CAD) have been observed in RSV patients, these individuals were more frequently managed with outpatient care rather than inpatient hospitalization.²

Population-Based Cross-Sectional Trial Results

Given the growing evidence that RVI vaccination can improve cardiovascular outcomes, along with the availability of RSV vaccines, the study authors noted that it is essential to compare the acute cardiac complications for RSV disease with those of other vaccine-preventable RVIs. The researchers conducted a cross-sectional study that compared the risk of acute cardiovascular complications in adults hospitalized for RSV versus those hospitalized for COVID-19 or influenza.¹

The population-based study was conducted in Singapore before the rollout of RSV vaccinations, analyzing data from 32,960 adult RVI hospitalizations between January 2017 and June 2024. The average age of hospitalized individuals for RSV, influenza, or COVID-19 was 66.58 years, with 63.7% of patients with at least 1 comorbidity, including cardiovascular disease (19.5%) and diabetes (35.2%). Additionally, 2148 adults were hospitalized for RSV and 14,389 for influenza between January 1, 2017, and June 30, 2024, while 16,423 adults were hospitalized for COVID-19 during the Omicron XBB/JN.1 transmission period in 2023 to 2024.¹

The results demonstrated that among the 2148 individuals hospitalized for RSV, 234 experienced an acute cardiovascular event and showed significantly higher odds of experiencing any acute cardiovascular event compared to those that received a COVID-19 booster. This includes specific events like dysthymia and heart failure. A similar development of increased odds for any acute cardiovascular event, such as dysrhythmias and heart failure, was observed in RSV individuals compared with upboosted COVID-19. While there was no significant difference in the odds of cardiovascular events between RSV and influenza overall, heart failure odds were notably higher in RSV hospitalizations compared to vaccine-breakthrough influenza cases during contemporaneous hospitalizations after the pandemic. Further, the occurrence of a cardiovascular event was linked to substantially greater odds of severe RSV requiring intensive care unit admission.¹

The researchers noted that, given the availability of RSV vaccines for older adults and ongoing vaccine skepticism, it is essential for pharmacists and health care providers to evaluate the role of vaccination in reducing the risk of cardiovascular events linked with vaccine-preventable RVIs. The findings suggest that individuals with a preexisting cardiac history are particularly vulnerable to acute cardiac events during RSV hospitalization and should be prioritized for vaccination.¹

REFERENCES

1. Wee E. L., Lim T. J., Ho R. W. L. R., Cardiac Events in Adults Hospitalized for Respiratory Syncytial Virus vs COVID-19 or Influenza. JAMA Network Open. May 22, 2025. Accessed May 29, 2025. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834362?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=052225

2. RSV and Heart Health. American Heart Association. Updated August 27, 2024. Accessed May 29, 2025. https://www.heart.org/en/health-topics/rsv