Prognosis of Laboratory-Confirmed Influenza and Respiratory Syncytial Virus in Acute Heart Failure

David Carballo, Nicolas Garin, Jérôme Stirnemann, Aline Mamin, Virginie Prendki, Philippe Meyer, Christophe Marti, Francois Mach, Jean-Luc Reny, Jacques Serratrice, Laurent Kaiser, Sebastian Carballo, David Carballo, Nicolas Garin, Jérôme Stirnemann, Aline Mamin, Virginie Prendki, Philippe Meyer, Christophe Marti, Francois Mach, Jean-Luc Reny, Jacques Serratrice, Laurent Kaiser, Sebastian Carballo

Abstract

Concomitant respiratory viral infections may influence clinical outcomes of acute decompensated heart failure (ADHF) but this association is based on indirect observation. The aim of this study was to evaluate the prevalence and impact of laboratory-confirmed influenza or respiratory syncytial virus (RSV) infection on outcomes in patients hospitalised for ADHF. Prospective cohort of patients hospitalised for ADHF with systematic influenza and RSV screening using real-time PCR on nasopharyngeal swabs. The primary outcome was all-cause mortality or readmission at 90 days. Among 803 patients with ADHF, 196 (24.5%) patients had concomitant flu-like symptoms of influenza. PCR was positive in 45 patients (27 for influenza, 19 for RSV). At 90 days, PCR positive patients had lower rates of all-cause mortality or readmission as compared to patients without flu-like symptoms (HR 0.40, 95% CI 0.18-0.91, p = 0.03), and non-significantly less all-cause mortality (HR 0.30, 95% CI 0.04-2.20, p = 0.24), or HF-related death or readmission (HR 0.36, 95% CI 0.13-0.99, p = 0.05). The prevalence of influenza or RSV infection in patients admitted for ADHF was low and associated with less all-cause mortality and readmission. Concomitant viral infection with ADHF may not in itself be a predictor of poor outcomes. (ClinicalTrials.gov NCT02444416).

Keywords: RSV; acute heart failure; influenza.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier survival analysis for 90-day clinical endpoints based on Influenza and respiratory syncytial virus (RSV) testing. Green: PCR positive, Red: PCR negative, Blue: patients without flu-like symptoms (no symptoms). (A). Survival without all-cause mortality or readmission, (B). Survival without all-cause mortality, (C). Survival without heart failure related mortality or readmission, (D). Survival without heart failure related mortality.

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