A new European Society of Cardiology clinical consensus statement highlights the pivotal role of vaccination in the prevention of major cardiovascular events. Here, its senior author and the Society’s president, Professor Thomas F. Lüscher, speaks to Julie Penfold about the statement’s key messages and the pressing need to inform cardiac patients about vaccination and tackle vaccine misinformation to support patient care.
Much of the current rhetoric surrounding vaccinations, spearheaded by the anti-vaccine stance of senior US politicians including health secretary, Robert Kennedy, was a key driver to produce a new European Society of Cardiology (ESC) clinical consensus statement on vaccination.
‘In the current context, we felt the statement was more important than ever to release,’ explains ESC president Professor Thomas F. Lüscher. ‘When we looked into the literature in detail, we felt that given the controversy about vaccinations, it would be very important to show that vaccination offers long-term benefits on the cardiovascular system beyond protection of an infection.’
This clinical consensus statement concludes that vaccination should be known as the fourth pillar of cardiovascular prevention, alongside the use of antihypertensives, lipid-lowering drugs and antidiabetic medications.
The statement was developed in conjunction with ESC speciality associations including the European Association of Preventative Cardiology, the Association for Acute Cardiovascular Care, the European Association of Cardiovascular Imaging, and the Heart Failure Association, alongside expert contributors.
Combining this specialist knowledge, the authors describe data on the risk of cardiovascular complications following infections such as pneumococcal pneumonia, influenza, SARS-CoV-2 (Covid-19) and respiratory syncytial virus (RSV), among others, and outlines the inflammatory mechanisms that may be responsible to provide an overall picture vaccination’s pivotal role in the prevention of cardiovascular events.
Infections, vaccines and cardiac complications
Viral infections such as influenza and Covid-19 are known to trigger acute myocardial infarction and exacerbate heart failure and other cardiovascular complications, with Professor Lüscher explaining that the risk of acute myocardial infarction after such an infection is of particular concern.
‘With the development of the understanding of the mechanisms of acute myocardial infarction, and particularly inflammation and plaque rupture, it became clear that the inflammatory burst that is associated with any infection can be a trigger that elicits an acute cardiac event,’ he says.
Recent evidence has also pointed to other viral and bacterial infections such as pneumonia and RSV being associated with increased cardiovascular morbidity and mortality.
As such, vaccination has a dual role of not only preventing infections but also reducing cardiovascular complications, particularly in at-risk patients with existing cardiovascular disease, and Professor Lüscher says that this is something that ‘even cardiologists may not have realised’.
The consensus statement also highlights the risks of cardiovascular adverse events after vaccination, such as myocarditis and pericarditis, and the strategies required to manage these.
A new UK study found that, while rare, the risk of cardiovascular complications in children is substantially greater after Covid-19 infection than following vaccination against the disease, which further highlights the preventative benefits of vaccination outlined in the ESC clinical consensus statement.
Protection for all hospitalised patients
With the spectrum of patients at risk of cardiovascular complications from common infections so vast, Professor Lüscher advises cardiac clinicians to be on high alert – particularly during the winter months where infections are at a peak.
‘We feel that everybody that is in hospital for a cardiac cause should receive a vaccine to protect against influenza and Covid-19. Added to this, if possible, patients should also receive an RSV vaccination,’ he says.
‘We also recommend that elderly patients and any cardiac patients should also receive the pneumococcal vaccination, in addition to the Covid-19 and influenza vaccines. Often people do develop a presentation of pneumonia after a fairly simple cold, and this may have deadly outcomes.’
While the consensus statement focuses on this range of vaccines for elderly patients, as well as family members of older at-risk patients also being vaccinated to support their protection, Professor Lüscher says he would consider vaccine protection ‘even patients above 50 years old’.
Pregnancy is another important consideration outlined in the consensus statement. Professor Lüscher notes that any patients with heart disease ‘who want to become pregnant should be vaccinated beforehand, and this is recommended by paediatricians as well as the ESC’, he says.
And any woman who becomes pregnant should be vaccinated ‘at the earliest opportunity’ for their own protection but also that of their baby, he adds.
Real-world analysis of the first season of maternal RSV vaccination, which was introduced in the UK in September 2024, found it was 72% effective in preventing hospitalisation for newborns whose mothers are vaccinated more than 14 days before delivery, further highlighting the benefits.
Prioritising vulnerable populations for vaccines
There are several other groups of cardiac patients who require particular attention. For example, patients who have experienced myocardial infarction are recommended for vaccination, as previously alluded to.
Patients who are due to undergo heart transplantation surgery should also be informed about vaccination, according to the consensus statement, and Professor Lüscher says that ‘cardiologists are very responsible for promoting this’.
These patients are especially vulnerable to infection due to immunosuppression after receiving a transplant and the impact this has on antibody development. Patients with advanced heart failure experience similar difficulties, Professor Lüscher adds, and should also be prioritised as ‘vaccination may help heart failure patients to produce at least some antibodies’.
Recommendations are also in place for adult patients with congenital heart disease. ‘These [patients] are [at] very, very high-risk of viral and bacterial infections and even complications in the brain, if bacterial infections embolise, as these can lead to brain abscesses,’ he explains.
When complex clinical scenarios present, such as patients experiencing severe cardiovascular conditions, best practice is to wait until they have stabilised, Professor Lüscher advises. Once stabilised, they can then be offered vaccinations.
Collaboration and vaccine education
The ESC is urging clinicians to work with primary care colleagues to highlight this consensus statement and build awareness of the link between infection and cardiac health throughout the healthcare system.
Working together to promote vaccination for vulnerable groups is key, and general practice and community pharmacies provide regular touchpoints for this to take place.
‘Vaccination is really not a very difficult procedure, all healthcare professionals have a role in providing protection,’ Professor Lüscher says.
To help with keeping the consensus statement at the forefront of clinicians’ minds, the ESC has developed a new artificial intelligence tool called ESC Chat. It can assist with answering clinical-related questions, and answers given are basely exclusively on current ESC clinical practice guidelines. It provides relevant citations from the respective full texts, and an in-built chat function enables users to ask follow-up questions.
In the current vaccination climate, a clearly referenced evidence base is the most crucial tool for supporting discussions between clinicians and patients, as well as helping to educate policy makers.
With vaccination research and usage grounding to a halt in the US – a situation Professor Lüscher says is ‘completely inappropriate’ – he is more hopeful that other countries will be open to engaging with the ESC’s consensus statement. He urges politicians across Europe and beyond to read it and take appropriate action.
‘In Europe, it’s certainly better than in the United States as far as governmental support for vaccinations is concerned, and their governments and regulatory bodies are usually more compliant with international guidelines,’ he explains. ‘But whether the patients will follow their advice is another question altogether.’
This statement alludes to the scepticism and hesitancy about vaccinations that continues to dominate a significant number of citizens across the continent – and in the German-speaking world in particular, Professor Lüscher says.
‘This could be due to the mindset that everything has to be natural, and while vaccines are perceived to be artificial, which they are,’ he admits, ‘they do in fact use our natural immunity. They are also very smart and offer infection protection. We have to bring this message over to patients.’