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we examined the first 60 &#40;2014&#41; and 59 &#40;2016&#41; patients with a primary diagnosis of HF at discharge &#40;diagnostic code 428&#46;0&#44; International Classification of Diseases-9th edition-Clinical Modification &#91;ICD-9CM&#93;&#41;&#46; The patients were chosen starting in January to ensure that the periods for the influenza vaccination campaigns were completed&#46; The explicit references in the discharge reports as to the advisability of the influenza vaccination were quantified&#46; The EHRs were exhaustively searched for such references &#40;made primarily by primary care&#41; in all of their sections&#46; The patient characteristics in 2014 and 2016 showed no significant variations&#44; except in mean age and ischemic etiology &#40;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 vs&#46; 82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 years and 20&#37; vs&#46; 41&#37;&#44; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 for both&#41;&#46; To analyze the study objectives&#44; we therefore grouped the samples selected in both periods &#40;2014 and 2016&#41; into one&#44; resulting in a total of 119 patients&#46; Fifty-eight percent of this group were women&#44; with HF of hypertensive &#40;83&#37;&#41; or valvular &#40;31&#37;&#41; etiology&#46; The left ventricular ejection fraction was measured in 92&#37; of the patients and was &#62;45&#37; in 75&#37; of the cases&#46; The comorbidities were atrial fibrillation &#40;78&#37;&#41;&#44; anemia &#40;58&#37;&#41;&#44; chronic obstructive pulmonary disease &#40;19&#37;&#41;&#44; neurological disease &#40;dementia or previous stroke&#41; &#40;33&#37;&#41;&#44; diabetes &#40;38&#37;&#41; and renal failure &#40;43&#37;&#41;&#46; The hospital survival rate was 90&#37;&#44; and mortality at 12 months was 34&#37;&#46; Sixty-seven percent of the unvaccinated patients died during hospitalization&#44; compared with 33&#37; of those who were vaccinated &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#46; The advisability of an influenza vaccination was mentioned in 7&#37; &#40;4&#47;60 in 2014&#41; and 5&#37; &#40;3&#47;59 in 2016&#41; of the discharge reports&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The coverage of the influenza vaccination in the medical history was 68&#37; &#40;41&#47;60&#41; in 2014 and 70&#37; &#40;41&#47;59&#41; in 2016&#46; In the remaining reviewed medical histories&#44; there was no reference to the state of vaccination&#46; In comparison&#44; the rate of vaccine coverage in the general population older than 65 years in Vigo&#44; Galicia&#44; Spain&#44; England &#40;the European country with the greatest vaccine coverage&#41; and USA are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#8211;6</span></a> Vigo was the area in Galicia with the least influenza vaccination coverage&#46; In any case&#44; none of the previously mentioned populations&#44; except for England&#44; reached the &#62;75&#37; objective recommended by European organizations&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In Vigo&#44; the influenza vaccination coverage in HF was greater than that of the rest of the population over 65 years of age&#46; However&#44; the 70&#37; coverage needs substantial improvement because the specific recommendation for influenza advises a figure close to 100&#37;&#46; In addition to age&#44; there are comorbidities for which the influenza vaccination is also recommended for patients with HF &#40;chronic obstructive pulmonary disease&#44; diabetes&#44; etc&#46;&#41;&#46; Between 2014 and 2016&#44; there was a slight improvement in the vaccine coverage&#46; However&#44; the low rate of vaccine recommendations in the discharge reports is worrying&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Adults older than 65 years constitute 50&#8211;70&#37; of all influenza-related hospitalizations and 85&#37; of influenza-related deaths&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> Respiratory infections are a common cause of exacerbation and hospitalization for patients with cardiovascular diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Particularly in HF&#44; respiratory infection is a common cause of readmission&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; in patients with HF&#44; the rate of influenza vaccinations is still low&#46; For example&#44; in the recent PARADIGM study&#44; the influenza vaccination rate among the more than 8000 participants from America&#44; Asia and Europe was 21&#37;&#44; although among the patients included in Spain&#44; the rate reached 52&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The influenza vaccination can attenuate the worsening prognosis of the HF caused by these respiratory infections&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> Even in a small series such as ours&#44; the mortality among the patients with HF was lower among the vaccinated patients&#46; It has recently been shown in Spain that the influenza vaccination prevents up to 36&#37; of readmissions for diseases that are exacerbated or related to the influenza infection&#44; including cardiovascular processes&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> Therefore&#44; the influenza vaccination represents a low-cost and highly effective measure for preventing the morbidity and mortality associated with HF&#44; which is generally recommended in the clinical practice guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although the influenza vaccination rates have stabilized in our department and healthcare area&#44; there is a certain relaxation in terms of its recommendation in the discharge reports&#46; We need to increase efforts by patients and practitioners so that this measure can be increasingly widespread in the at-risk population&#46; Our center&#39;s department of preventive medicine has therefore intensified the measures aimed at achieving practically universal coverage of the influenza vaccination for hospitalized patients&#46;</p></span>"
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Correspondence
Influenza vaccination and heart failure. A priority field for improvement
Vacunación antigripal e insuficiencia cardiaca. Un prioritario campo de mejora
J. Montes-Santiagoa,
Corresponding author
julio.montes.santiago@sergas.es

Corresponding author.
, A. Blanco Rodiciob, P. Domínguez Erquiciaa, G. Rey-Garcíac
a Medicina Interna, Estructura Organizativa de Gestión Integrada, Vigo, Pontevedra, Spain
b Medicina de Familia, Estructura Organizativa de Gestión Integrada, Vigo, Pontevedra, Spain
c Documentación Clínica, Estructura Organizativa de Gestión Integrada, Vigo, Pontevedra, Spain

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