We read with interest the letter by Barrios and Escobar responding to our editorial, titled “Vaccination in Heart Failure: An Approach to Improve Outcomes”.1 We would like to clarify that our editorial focused exclusively on the impact of anti-influenza and/or antipneumococcal vaccination in patients with already established heart failure (HF) rather than those without a history of HF. It is rational to assume that, if respiratory infections are an important cause of HF hospitalization, preventing such infections would prevent HF patients from frequent readmissions and worsening disease. In agreement with this assumption, large-scale, observational studies or population-based registries have reported a reduction in hospitalization rate of vaccinated HF patients.2,3 On the other hand, limited data indicate that anti-influenza and antipneumococcal vaccination may not further improve clinical outcomes after discharge of HF patients4 or their annual efficacy may be limited only during the “flu seasons”.5 Notably, international guidelines have recommended anti-influenza and antipneumococcal vaccination in HF population based on either level of evidence IIb or on self-care skills or education plans.1 Thus, there are data favoring immunization against influenza and pneumococcal viruses as a cost-effective, preventive measure in the HF population. However, those data are not strong enough to allow firm conclusions. We need more evidence, derived from studies properly designed for HF populations, balancing the risk-benefit ratio and not being extrapolated from general community or “heart disease” patients. Worldwide, the vaccination rate remains low and only evidence-based data will encourage the endorsement of international vaccination programs in HF therapeutic strategies.
Conflicts of interestJ. Parissis received honoraria for lectures from Pfizer.