RSV's Impact on Heart Health Emphasizes Broader Risks, Vaccination Importance for Older Adults

Respiratory syncytial virus (RSV) poses a significant, often overlooked, risk for serious cardiovascular complications in older adults, underscoring the critical need for vaccination in this population regardless of their preexisting health conditions. | Image Credit: Art_Photo - stock.adobe.com

Respiratory syncytial virus (RSV) significantly increases the risk of serious postdischarge cardiovascular complications in older adults, emphasizing the critical need for vaccination in this population, regardless of preexisting health conditions, according to a study published in the Journal of the American Geriatrics Society.¹

Traditionally, RSV risk in adults 60 years or older is low compared with that in children. Vaccine development and approvals have offered a method of preventing RSV for adults 60 years and older. The FDA approved both RSVPreF3 (Arexvy; GSK) and RSVpreF (Abrysvo; Pfizer) in May 2023.^2,3 A year later, the FDA approved the mRNA-1345 (mRESVIA; Moderna) vaccine for RSV for adults 60 years and older.⁴

Current guidelines for RSV vaccination, updated by the Advisory Committee on Immunization Practices in June 2024, recommend a single dose of any FDA-approved RSV vaccine for 2 key groups: adults 75 years and older as well as adults aged 60 to 75 years who face an increased risk of severe RSV.⁵ This update supersedes the CDC's June 2023 recommendation, which previously suggested a single dose for individuals 60 years and older based on shared clinical decision-making.

Before the COVID-19 pandemic, RSV, Streptococcus pneumoniae, and influenza contributed most significantly to the global burden of acute respiratory infections.¹ These conditions caused approximately 1.2 million deaths and 22 million disability-adjusted life-years lost annually in adults 60 years or older.

Researchers conducted a retrospective cohort study to estimate the subsequent rate of cardiovascular events and other serious outcomes in older adults hospitalized for RSV. They compared the incidence of these outcomes with the incidence in patients from 3 diverse groups: those hospitalized for influenza, urinary tract infections (UTIs), and fractures.

Initially, before matching, researchers identified 104,095 patient admissions attributed to RSV (n = 2558), influenza (n = 16,688), UTIs (n = 73,587), or fractures (n = 11,262). After matching, 2234, 2308, and 1612 pairs remained for comparing RSV patients with those who had influenza, UTIs, and fractures, respectively. Within these matched pairs, women made up over 60% of the cohort, with a mean age of 80 years, and approximately half had received an influenza vaccination.

Around 7% of patients were highly frail, and comorbidities were common. Specifically, chronic obstructive pulmonary disease and dyslipidemia affected about 45% of patients each. Diabetes was present in roughly 40%, while atrial fibrillation and asthma each impacted about 30%. Heart failure was also seen in approximately 28% of patients. These conditions were significantly more prevalent in patients with RSV compared with other patient groups before matching occurred.

Before matching, 19% of patients hospitalized for RSV (474 individuals) experienced a subsequent cardiovascular outcome, a higher rate than seen in patients hospitalized for influenza (18%; 2961 individuals), UTIs (12%; 8908 individuals), or fractures (8%; 941 individuals). After matching, heart failure was the most common outcome for patients with RSV (10%-11%), followed by atrial fibrillation (5%-6%).

Patients with RSV experienced higher rates of heart failure compared with those with influenza (HR, 1.65; 95% CI, 1.14-2.38), UTIs (HR, 1.92; 95% CI, 1.28-2.88), and fractures (HR, 1.81; 95% CI, 1.41-2.31). This elevated risk held true for individuals both with and without a preexisting cardiovascular condition, though the difference between RSV and influenza was not statistically significant in these groups.

Patients with RSV also experienced a higher rate of atrial fibrillation compared with those with fractures (HR, 1.50; 95% CI, 1.08-2.08). Notably, among individuals with no prior cardiovascular conditions, the rate of atrial fibrillation in patients with RSV was 2.61 times higher than in those with UTIs (95% CI, 1.29-4.91) and 2.29 times higher than in those with fractures (95% CI, 1.14-4.58).

Even without preexisting cardiovascular conditions, patients with RSV faced higher odds of needing intensive care. Compared with those with UTIs and fractures who also lacked preexisting cardiovascular issues, patients with RSV had a substantially increased risk of intensive care unit transfer (OR, 3.75-4.63). Furthermore, RSV was associated with a higher 30-day mortality rate, ranging from 1.49 to 3.98 times greater. Patients with RSV also experienced hospital stays that were 11% to 32% longer. While the risk of 30-day readmission was significantly higher for patients with RSV compared with those with fractures (1.36; 95% CI, 1.08-1.71), it was lower than for patients with UTIs (0.73; 95% CI, 0.59-0.9).

Several limitations constrain this study's findings, including the design that focused only on cases within specific RSV and influenza seasons, which, while reducing seasonal confounding, also limited the data's breadth. Relying on administrative data for cardiovascular events prevented in-depth analysis of event sequences during initial admissions. Similarly, acute respiratory infection admissions were categorized administratively, not by lab confirmation. Unmeasured patient characteristics may have also confounded the results. Furthermore, the low number of RSV admissions could reflect sampling biases, possibly from excluding health care–associated acute respiratory infections or current RSV testing practices.

“Although RSV infections are less common than influenza in older adults, they remain a substantial source of economic burden to healthcare systems. Our findings underline the importance of robust and effective public health strategies regarding RSV vaccines,” study authors concluded.

References

1. Verschoor CP, Cerasuolo JO, Caswell JM, et al. Respiratory syncytial virus (RSV)-related hospitalization and increased rate of cardiovascular events in older adults. J Am Geriatr Soc. Published online July 23, 2025. doi.org/10.1111/jgs.19591
2. FDA approves first respiratory syncytial virus (RSV) vaccine. FDA. News release. May 4, 2023. Accessed July 22, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine
3. US FDA approves ABRYSVO, Pfizer’s vaccine for the prevention of respiratory syncytial virus (RSV) in older adults. News release. Pfizer. May 31, 2023. Accessed July 22, 2025. https://www.pfizer.com/news/press-release/press-release-detail/us-fda-approves-abrysvotm-pfizers-vaccine-prevention
4. Moderna receives US FDA approval for RSV vaccine mRESVIA(R). News release. Moderna. 2025. Accessed July 22, 2025. https://feeds.issuerdirect.com/news-release.html?newsid=6933586831574780&symbol=MRNA
5. Ferruggia K. Rise in RSV infections is associated with a decrease in vaccine hesitancy. Pharmacy Times^®. January 7, 2025. Accessed July 22, 2025. https://www.pharmacytimes.com/view/rise-of-rsv-infections-is-associated-with-a-decrease-of-vaccine-hesitancy