Respiratory Syncytial Virus (RSV) is a common respiratory virus. Nearly all children will contract RSV by the time they’re two and it affects approximately 65 million people on an annual basis.
Impact of RSV
In the United States alone, up to 160,000 adults and 80,000 children are hospitalized every year for more serious cases of RSV. There’s a strong correlation between RSV and heart health in more serious cases of RSV.
Around 14 to 22% of hospitalizations for adult patients are complicated by cardiovascular issues including worsening congestive heart failure, acute coronary syndrome and arrhythmias. Underlying cardiovascular disease has also been linked to 45 to 63% of adult hospitalizations for RSV.
Complications from RSV
While most cases of RSV will remain mild, serious complications can occur, including bronchitis, lung infections, pneumonia and worsening conditions like asthma, chronic obstructive pulmonary disease and congestive heart failure.
Studies have shown that up to 22% of hospitalized adults experience cardiovascular complications, such as worsened congestive heart failure, new arrhythmia and stroke.
Patients need to understand the heightened risks they face through RSV – and how to best protect themselves from RSV, especially if they’re in a more vulnerable population.
RSV: Risk-Factors and Cardiovascular Complications
Older adults and adults with chronic medical conditions are at an increased risk of severe RSV and cardiovascular complications. Some of the populations that face the highest risk of RSV include:
- Adults over 60
- Adults with weakened immune systems
- Adults with chronic medical conditions like lung disease, cardiovascular diseases including congestive heart failure and coronary artery disease, kidney disorders, and neurologic conditions.
Cardiovascular Complications - Causes
Severe cases of RSV are frequently complicated by cardiovascular issues, which can lead to hospitalization and increased mortality. Studies have shown that underlying cardiovascular disease is present in up to 63% of hospitalized adults. And 14-22% of adult patients hospitalized for RSV deal with cardiovascular complications including worsening congestive heart failure, acute coronary syndrome and arrhythmias.
Researchers believe RSV primarily impacts cardiovascular health through the respiratory tract, such as when pulmonary hypertension causes a right ventricular strain, and through the inflammatory response. Inflammation can cause acute coronary syndrome, as it triggers plaque destabilization and rupture. Higher levels of fibrinogen and thrombin, as well as increased platelet binding, may also increase the risk of ACS.
RSV has also been linked to myocardial damage. And the physiologic and metabolic stress associated with an acute illness like RSV may lead to ischemia and increased risk of atrial fibrillation.
Cardiovascular Complications - Known and Unknown Heart Disease
RSV has been associated with worsening cardiovascular conditions such as arrhythmias, heart failure and myocardial infarction, both in patients with and without known diagnoses of these conditions.
Patients face a higher risk of MI or stroke immediately after contracting RSV. The highest risk is within three days of infection but remains heightened for up to 90 days.
Adults with CHF and RSV are more likely to require inpatient care. Researchers found patients with CHF had eight times the rate of hospitalizations than those without. And over 5% of all hospitalizations for CHF during RSV season are due to RSV infection. The correlation is even higher for older adults. One study found that 20% of elderly patients who had been admitted due to RSV had a primary discharge diagnosis of CHF.
High rates of underlying CAD have been found in patients with RSV, though one study found that those patients were more likely to receive outpatient care than inpatient.
You can help your patients with underlying cardiac issues or risks by educating them about the potential impact to their health if they contract RSV.
Diagnosing RSV Cases and Preventing the Spread of Disease
Historically, RSV has been a seasonal illness that starts in the fall and peaks in winter, though COVID-19 disrupted some of its predictability in 2020 and the CDC is uncertain what to expect into the future.
When adult patients with cardiovascular disease or CVD risk factors present with respiratory symptoms, the possibility of RSV and its associated risks should be considered. Help the patient take steps to prevent spread, manage their condition and watch for worsening CVD symptoms that may require hospitalization.
It can be challenging to distinguish RSV from other seasonal respiratory illnesses, like influenza and the cold, because they share many symptoms, including coughing, sneezing, and congestion. The CDC recommends using rRT-PCR assays to confirm an adult diagnosis of RSV as it’s more sensitive than culture and antigen testing.
Some of the most important precautions to prevent the spread of RSV include: washing your hands, not touching your face, covering coughs and sneezes, disinfecting surfaces, staying home when you’re sick and experiencing any cold-like symptoms, and avoiding close contact with sick people.
Helping your patients prevent RSV infection and making sure they work with a health care team if they do get sick is key to helping them stay well.
A Promising New Vaccine
Two new vaccines, recently FDA-approved and recommended for adults over 60 by the CDC, will be accessible late July 2023. Research indicates a single shot can cut the risk of symptomatic illness by 83% and severe illness by 94%. Older patients with heart and lung issues are a key target group for this vaccine.
The American Heart Association offers continuing education on the impact of RSV on older adults’ heart health.
Adults at highest risk for severe RSV infection include older adults, especially those 65 years and older, adults with chronic heart or lung disease, and adults with weakened immune systems. You can help your patients with underlying cardiac issues or risks by educating them about the potential impact to their health if they contract RSV.
This educational activity is supported by an educational grant from GSK.