June 03, 2016
Expert Q&A: Orly Vardeny, PharmD, MS
Are patients with preexisting heart problems who receive influenza vaccinations at less risk of suffering lung infections and a worsening of their heart conditions or are they just less likely to get the flu? To find out, Dr. Orly Vardeny, an associate professor at the University of Wisconsin-Madison’s School of Pharmacy, and a team of researchers have enrolled 200 adults with history of heart attack or heart failure in a pilot study that will run during the current season. The research team will expand the study by enrolling 3,000 patients over the next 3 flu seasons to include a total of 9,300 patients at 180 clinical sites across the United States and Canada.
Dr. Vardeny’s previous research indicated that a higher dose influenza vaccine improves the immunization response of patients with heart issues. Now she’s trying to figure out how high-dose and standard dose influenza vaccines impact hospitalization rates for treatment of heart- and lung-related issues. We recently asked Dr. Varney about her goal of making the flu season safer for patients with underlying heart conditions and why her study could ultimately help increase immunization coverage among this patient population.
Why are patients with heart disease at risk during flu season?
Patients with any chronic condition, but especially heart disease, are more likely to suffer influenza-related complications. Their underlying heart issues are likely to deteriorate if they get sick, because influenza sets in motion a number of physiological factors that worsen their overall health condition. For example, heart failure patients infected with the flu might suffer acute exacerbations that result in hospitalization. Healthcare providers are definitely aware of the overall risk of influenza and do a great job of advocating for vaccination. However, the added risk for people with heart disease is not as widely recognized.
What’s the ultimate goal of your research?
Influenza vaccination is a very simple once-a-year intervention that has the potential to greatly reduce the risk of cardiac events in heart disease patients. In previous research, we found that people with heart disease don’t have a good immune response to the standard vaccine compared with individuals without heart disease, perhaps because heart failure or a recent heart attack compromise the immune system. Would a higher dose of the vaccine offer them more protection? That’s what we’re trying to figure out. The subtlety of this trial is that we’re comparing a high dose of the trivalent vaccine, which contains 3 antigens, with a standard dose of the quadrivalent vaccine, which contains 4 antigens. Is it better to have more of fewer viruses or is it better to have wider coverage? We don’t yet know the answer to that.
What can be done to convince more patients to get flu shots?
The vaccination rate in some of our largest heart failure trials was only 50%, so there’s a need to improve coverage. People have concerns about influenza vaccination. The most common misconception we hear is that it causes the flu. That’s simply not true. Patients and individuals in the general population need to understand that the vaccine is a killed virus that’s meant to make the body’s immune response stronger when it encounters influenza virus during flu season. Even if the vaccine isn’t perfectly matched to the strains that circulate during a season, it will still lessen the severity of the illness. Influenza vaccine is one of the best health interventions patients can undergo.
How can health providers help
educate patients about the benefits of vaccination?
That’s a good question. There are countless missed opportunities during patient interactions to emphasize the importance of flu shots. Any interaction with a patient is an opportunity to vaccinate. Healthcare providers, especially at non-primary care clinics, should have the influenza vaccination on hand. Look at the VA hospitals — providers at each clinic carry the vaccine and every patient who walks in the door is asked if they’ve had a flu shot. They have an opportunity to get vaccinated, no matter where they seek care. That’s how it should be in every health system, particularly with respect to the care of heart patients.
Is there a way to enhance efforts to vaccinate as many people as possible?
We think so. We’re using our study as an opportunity to test if electronic health records can be used to track patients and identify vaccination candidates, and whether that information is precise enough. We’re looking for better ways to identify candidates for vaccination in advance of the flu season, because we have a very short window to recruit subjects before they get immunized. We’d also like to see if the use of electronic health records increases immunization coverage by getting patients to consent to vaccination electronically and alerting their healthcare providers when they do. That presents the possibility of improving coverage by using electronic health records to send targeted information about seasonal vaccination to patients and their providers.
—Interview conducted by Dan Cook