Researchers identified adults aged 60 years or older with heart failure and compared clinical outcomes according to their RSV vaccination status. Following propensity score matching, the analysis included 777 vaccinated patients and 777 unvaccinated patients, with well-balanced baseline demographic characteristics, comorbidities and medication use between the two groups.
All-cause mortality occurred in 3.8% of vaccinated patients, compared with 11.1% of those who had not received the vaccine. RSV vaccination was associated with a 49% lower hazard of death, with a hazard ratio of 0.51 and a 95% confidence interval of 0.33 to 0.79.
The findings indicate a substantial association between vaccination and lower mortality in this high-risk population, although the observational study design does not establish that vaccination directly caused the difference.
ICU Admissions Also Lower Among Vaccinated Patients
ICU admissions were significantly less frequent among vaccinated patients, occurring in 2.7% of the vaccinated group compared with 5.8% of the unvaccinated group. The difference corresponded to a hazard ratio of 0.46.
However, the analysis found no statistically significant differences in several other clinically important outcomes. Respiratory failure occurred in 7.3% of vaccinated patients and 9.4% of unvaccinated patients, while inpatient or emergency visits were recorded in 29.9% and 35.1%, respectively. Neither difference reached statistical significance.
The rates of heart failure exacerbation, myocardial infarction and stroke were also similar between the two groups. Age-stratified analyses involving patients aged 60 to 75 years and those aged 75 to 90 years showed the same overall pattern, with no significant differences in cardiovascular events.
Higher Healthcare Utilisation Raises Questions About the Findings
Overall healthcare utilisation was significantly higher among vaccinated patients, with a hazard ratio of 1.85. The investigators noted that this difference may reflect greater engagement with outpatient and nonacute care among individuals who chose to receive the vaccine.
This disparity is an important consideration when interpreting the observed mortality difference. Although propensity score matching balanced measured baseline characteristics, the observational analysis could not account for several potentially influential factors, including frailty, heart failure severity, functional status, socioeconomic position and the completeness of guideline-directed therapy.
These limitations mean that unmeasured differences between the vaccinated and unvaccinated groups may have influenced the results. Consequently, the association between RSV vaccination and lower mortality cannot be interpreted as proof that vaccination itself produced a survival benefit.
The authors described the findings as hypothesis-generating rather than evidence of a causal survival benefit. For clinicians treating older adults with heart failure, the results provide a basis for further investigation into whether RSV vaccination may help reduce the most severe clinical outcomes in this high-risk population.
The study, titled “Association of RSV Vaccination With Clinical Outcomes in Older Adults With Heart Failure: A Propensity-Matched Analysis,” was authored by Khan A et al. and published in Clinical Cardiology in 2026, volume 49, issue 10.
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