The Prevalence and Outcomes of Influenza Virus Infection in Heart Failure Patients in Brazil: Influenza Infection in Heart Failure


Background: Respiratory tract infections were associated with acute exacerbations of heart failure (HF). However, the role of the influenza virus, a major agent of such infections, in this population remained unclear. Method: During the influenza virus seasons of 2013 and 2014 we prospectively assessed influenza respiratory illnesses in a cohort of adults primarily hospitalized for management of acute decompensated HF and a cohort of HF outpatients. Qualitative RT-PCR for influenza A (A/H1, A/H12009pdm, A/H3) and B virus testing was performed on nasopharyngeal swab samples. Result: A total of 121 patients were included, 58.3% males (n = 70), mean age 57.7 years old (±14.0), mean left ejection fraction 35.3 (±9.8). Of these, 50.4% were inpatients (n = 61). The prevalence of symptoms of respiratory infections was 28.0% (n = 34) and 4.9% (n = 6) of all samples were positive for influenza virus. Only influenza A was detected and all cases were among inpatients. Influenza-positive patients had a greater need for antimicrobials (83.3%, n = 5; 16.3%, n= 9; p = 0.001) and for mechanical ventilation (50.0%, n = 3; 3.6%, n = 2; p < 0.001) than Influenza-negative patients. The prevalence of influenza virus was not related to mortality (OR 4.58; p = 0.16). Conclusion: Although not common, the influenza virus infection resulted in worst outcomes, with a greater need for antimicrobials and mechanical ventilation. Immunization and antiviral treatment in high risk patients may positively impact their outcomes.

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Godoy, H. , Soares, J. , Neves, P. , Bellei, N. and Almeida, D. (2015) The Prevalence and Outcomes of Influenza Virus Infection in Heart Failure Patients in Brazil: Influenza Infection in Heart Failure. Advances in Infectious Diseases, 5, 95-100. doi: 10.4236/aid.2015.53011.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Mandell, L.A., Wunderink, R.G. and Anzueto, A. (2007) Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases, 44, S27-S72.
[2] World Health Organization (2009) Fact Sheet on Influenza.
[3] Thompson, W.W., Shay, D.K., Weintraub, E., Brammer, L., Bridges, C.B., Cox, N.J. and Fukuda, K. (2004) Influenza-Associated Hospitalizations in the United States. Journal of the American Medical Association, 292, 1333-1340.
[4] Harper, S., Bradley, .J, Englund, J., File, T., Gravenstein, S., Hayden, F., McGeer, A., Neuzil, K., Pavia, A., Tapper. M., Uyeki, T., Zimmerman, R. and America, E. (2009) Seasonal Influenza in Adults and Children—Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management: Clinical Practice Guidelines of the Infectious Diseases Society of America. Clinical Infectious Diseases, 48, 1003-1032.
[5] Wongsurakiat, P., Maranetra, K., Wasi, C., Kositanont, U., Dejsomritrutai, W. and Charoenratanakul, S. (2004) Acute Respiratory Illness in Patients with COPD and the Effectiveness of Influenza Vaccination: A Randomized Controlled Study. Chest, 125, 2011-2020.
[6] Godoy, H.L., Silveira, J., Segalla, E. and Almeida, D. (2011) Hospitalization and Mortality Rates for Heart Failure in Public Hospitals in Sao Paulo. Arquivos Brasileiros de Cardiologia, 97, 402-407.
[7] Stewart, S., McIntyre, K., Capewell, S. and McMurray, J.J. (2002) Heart Failure and Cold Climate. Seasonal Variation in Heart Failure Related Mortality. Journal of the American College of Cardiology, 39, 760-766.
[8] Boulay, F., Berthier, F., Sisteron, O., Gendreike, Y. and Gibelin, P. (1999) Seasonal Variation in Chronic Heart Failure Hospitalizations and Mortality in France. Circulation, 100, 280-286.
[9] Sandoval, C., Walter, S., Krueger, P., Smieja, M., Smith, A., Yusuf, S. and Loeb, M. (2007) Risk of Hospitalization during Influenza Season among a Cohort of Patients with Congestive Heart Failure. Epidemiology and Infection, 135, 574-582.
[10] Gheorghiade, M., Vaduganathan, M., Fonarow, G. and Bonow, R. (2008) Rehospitalization for Heart Failure: Problems and Perspectives. Factors Identified as Precipitating Hospital Admissions for Heart Failure and Clinical Outcomes Findings from OPTIMIZE-HF. Archives of Internal Medicine, 168, 847-854.
[11] Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Blaha, M.J., Dai, S., Ford, E.S., Fox, C.S., Franco, S., Fullerton, H.J., Gillespie, C., Hailpern, S.M., Heit, J.A. and Howard, V.J. (2014) AHA Statistical Update: Heart Disease and Stroke Statistics—2014 Update: A Report from the American Heart Association. Circulation, 129, e28-e292.
[12] Kannel, W.B. (2000) Incidence and Epidemiology of Heart Failure. Heart Failure Reviews, 5, 167-173.
[13] Jessup, M., Abraham, W.T., Casey, D.E., Feldman, A.M., Francis, G.S., Ganiats, T.G., Konstam, M.A., Mancini, D.M., Rahko, P.S., Silver, M.A., Stevenson, L.W. and Yancy, C.W. (2009) 2009-Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. Journal of the American College of Cardiology, 53, 1343-1382.
[14] Centers for Disease Control and Prevention. CDC Protocol of Real Time RT-PCR for Influenza A (H1N1).
[15] Informe técnico de influenza e vigilancia de síndrome respiratória aguda grave (SRAG), de síndrome gripal (SG) e de internacoes por CID J09 a 118. Ministério da saúde. Secretaria de vigilancia em saúde. _25_03.pdf
[16] Melchior, T., Perosa, A., Camargo, C., Granato, C. and Bellei, N. (2015) Influenza Vírus Prevalence in Asymptomatic and Symptomatic Subjects during Pandemic and Postpandemic Periods. American Journal of Infection Control, 43, 460-464.
[17] Bellei, N., Carraro, E., Perosa, A. and Granato, C. (2007) Patterns of Influenza Infections among Different Risk Groups in Brazil. Brazilian Journal of Infectious Diseases, 11, 399-402.
[18] Davis, M.M., Taubert, K., Benin, A.L., Brown, D.W., Mensah, G.A., Baddour, L.M., Dunbar, S. and Krumholz, H.M. (2006) Influenza Vaccination as Secondary Prevention for Cardiovascular Disease. Circulation, 114, 1549-1553.
[19] Gurfinkel, E., Fuente, R., Mendiz, O. and Mautner, B. (2004) Flu Vaccination in Acute Coronary Syndromes and Planned Percutaneous Coronary Interventions (FLUVACS) Study. European Heart Journal, 25, 25-31.
[20] Singleton, J.A., Wortley, P. and Lu, P.J. (2004) Influenza Vaccination of Persons with Cardiovascular Disease in the United States. Texas Heart Institute Journal, 31, 22-27.
[21] Bocchi, E.A., Braga, F.G., Ferreira, S.M., Rohde, L.E., Oliveira, W.A., Almeida, D.R., Moreira, M.C., Bestetti, R.B., Bordignon, S., Azevedo, C., Tinoco, E.M., Rocha, R.M., Issa, V.S., Ferraz, A. and Cruz, F. (2009) Sociedade Brasileira de Cardiologia. III Diretriz Brasileira de Insuficiência Cardíaca Cr?nica. Arquivos Brasileiros de Cardiologia, 93, 1-71.
[22] Bautista, E., Chotpitayasunondh, T., Gao, Z., Harper, S.A., Shaw, M., Uyeki, T.M., Zaki, S.R., Hayden, F.G., Hui, D.S., Kettner, J.D., Kumar, A., Lim, M., Shindo, N., Penn, C. and Nicholson, K.G. (2010) Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection. New England Journal of Medicine, 362, 1708-1719.
[23] Kumar, A., Zarychanski, R., Pinto, R., Cook, D.J., Marshall, J., Lacroix, J., Stelfox, T., Bagshaw, S., Choong, K., Lamontagne, F., Turgeon, A.F., Lapinsky, S., Ahern, S.P., Smith, O. and Siddiqui, F. (2009) Critically Ill Patients with 2009 Influenza A (H1N1) Infections in Canada. JAMA, 302, 1872-1879.
[24] Jain, S., Kamimoto, L., Bramley, A.M., Schmitz, A.M., Benoit, S.R., Louie, J., Sugerman, D.E., Druckenmiller, J.K., Ritger, K.A., Chugh, R., Jasuja, S., Deutscher, M., Chen, S., Walker, J.D. and Duchin, J.S. (2009) Hospitalized Patients with 2009 H1N1 Influenza in the United States, April-June 2009. New England Journal of Medicine, 361, 1935-1944.
[25] Centers for Disease Control and Prevention (2009) Hospitalized Patients with Novel Influenza A (H1N1) Virus Infection: California, April-May, 2009. Morbidity and Mortality Weekly Report, 58, 536-541.
[26] Kaiser, L., Wat, C., Mills, T., Mahoney, P., Ward, P. and Hayden, F. (2003) Impact of Oseltamivir Treatment on Influenza-Related Lower Respiratory Tract Complications and Hospitalizations. Archives of Internal Medicine, 163, 1667-1672.

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