This news doesn’t bode well for the United States, where, historically, the same flu tends to enter the country later in the year. Last month, the chief medical officers of the American Heart Association, American Diabetes Association, and American Lung Association hosted a panel to discuss the upcoming wave of the flu and what Americans can do to combat it. “We’re concerned that this may be the worst flu season that we’ve seen in the last year or two,” says Albert Rizzo, MD, chief medical officer of the American Lung Association. “Individuals should start planning on getting their flu shots now.” For those with heart disease, the concern is especially high.
What Are My Chances of Getting the Flu if I Have Heart Disease?
While there isn’t an agreed-upon statistic that indicates exactly how many people with heart disease get the flu each year, researchers can make some best guesses. “We estimate that 125 million people or so have diagnosable cardiovascular disease in this country,” says Eduardo Sanchez, MD, chief medical officer for prevention for the American Heart Association. “The same percentage that gets the flu in general affects those with cardiovascular disease to at least that level of percentage.” According to the Centers for Disease Control and Prevention (CDC), that could be between 3 and 11.3 percent of the U.S. population, with a median chance of 8.3 percent of the population being affected. For those with heart disease, median odds mean that 10.4 million people could contract the flu.
Does the Flu Affect People With Heart Disease Differently?
If you have heart disease, you’re more likely to develop complications from the flu, including pneumonia, bronchitis, lung failure, and heart attack, according to Mayo Clinic. It can also worsen diabetes, asthma, and other preexisting conditions. That is in addition to the typical flu symptoms, which range from fever and body aches to shortness of breath and respiratory failure. There is a reason for that, says Dr. Sanchez: The body is just not very good at multitasking. “Your body has a hard time responding to lots of challenges, whether that’s climbing a mountain, shoveling snow in your yard, or dealing with an infection like influenza,” he says. Unfortunately, the flu is known to increase the risk of serious or life-threatening cardiac events. A study published by the CDC in 2020 found that 1 in 8 patients hospitalized with the flu had sudden heart complications. Of those patients, one-third were admitted to the intensive care unit, and 7 percent died. The heart complications included inflammation or damage to the heart muscle, fluid surrounding the heart, and a weakened heart pumping function.
Who Should Be Most Concerned About the Flu?
Everyone who is older than 6 months of age should get the flu vaccine to protect themselves from influenza, per the CDC. But a couple of groups are considered especially high risk, given their prevalence of heart disease. The first are those age 65 and older, who are more likely to suffer from cardiac events due to a weakened heart, according to the National Institute on Aging. The good news is that their typical flu vaccination rate is higher than that of any other demographic. In 2021, 75.2 percent of people in that age group were vaccinated, more than 20 percentage points higher than the next most vaccinated age group. The second group is minority communities. Black Americans are 30 percent more likely to die of heart disease, compared with non-Hispanic whites. Unlike the elderly population, which is consistently the group with the highest flu vaccine rates each year, Black and Hispanic communities have the lowest rates of vaccinations each year, with their 2021 rates being 40.4 percent and 38.6 percent, respectively. “Minority populations were less likely to get the flu vaccine,” says Gary A. Puckrein, PhD, president and CEO of the National Minority Quality Forum, who also spoke at the panel discussion. “Secondly, even if they got the flu vaccine, they were less likely to get the high dose.” Since the flu can exacerbate respiratory and cardiovascular issues, the consistently low vaccination rates in these communities is a cause of concern. “We want to close all of these gaps that exist, because the one thing we do know is that cardiovascular disease disproportionately affects Black people for a whole host of reasons,” says Sanchez. “Some of it is about access to care. Some of it has to do with social-needs factors, not having money and not having access to primary care and living in pharmacy deserts.” Dr. Puckrein also points out that minority communities have higher vaccine-hesitancy rates, due to the spread of misinformation. “I just want to reinforce that the vaccine does not cause the flu,” he says. “A lot of people have it in their head that if they get vaccinated, they will get the flu.”
How Does the Flu Vaccine Protect People With Heart Disease?
For those diagnosed with cardiovascular disease, the flu shot protects against more than just the flu. “The flu shot is going to protect them from an increased risk of what are called cardiovascular events,” says Sanchez. “Heart attacks and strokes are two kinds of cardiovascular events that happen more frequently in those who get the flu and have not been vaccinated.” People who have heart disease and are vaccinated against the flu have a 37 percent less chance of being hospitalized for the flu, and a 50 percent less chance of having out-of-hospital cardiac arrest for 12 months following the vaccination, according to UCLA Health. What’s more, a meta-analysis published in 2020 by the American Heart Association found, after reviewing 16 separate studies covering more than 237,000 people, that those with heart disease who were also vaccinated for the flu were 18 percent less likely to die from heart problems and 28 percent less likely to die from other causes. But the key is to get vaccinated. Research from the American College of Cardiology found that as of 2018–2019, only half of heart disease patients get the flu shot each year. Unfortunately, how the flu and COVID-19 interact is still unclear, especially in those with long COVID. However, Dr. Rizzo warns that if you have respiratory problems due to COVID-19, your lungs “might not be able to handle another respiratory infection as well as you otherwise might have.”
What Is the Best Way to Get the Flu Shot?
“Any of the large retail pharmacies, whether they’re associated with supermarkets or chains, generally offer flu vaccines,” says Sanchez. “And you should not be paying any money for it.” If you are over 65, a new high-dose flu vaccination called Fluzone High-Dose Quadrivalent is available this year. It contains four times the amount of antigen as the standard-dose flu vaccines and is preferentially recommended by the CDC for people age 65 and older. However, you may have to request the high-dose vaccine specifically, as it may not automatically be given. “I am a believer that all patients should know what they should be getting,” says Sanchez. “Patients should always be asking is this ‘that’ because that’s what I know the recommendation is for me.” In minority communities, Puckrein has seen faith-based programs make getting vaccinations easier for their members. “Most churches have a health group that helps those in the congregation,” he says. “They do vaccinations and are active in the community in terms of outreach. They are a tremendous source of information and set up programs to get folks appropriately vaccinated.” And what if there are financial concerns or other barriers to accessing the flu vaccine, such as transportation or pharmacy access? In those cases, Sanchez recommends calling the local health department or your primary healthcare provider for assistance.
Can You Get the Flu Shot and COVID Booster at the Same Time?
In September, the CDC announced that it is recommending the updated COVID-19 booster from Pfizer-BioNTech for people ages 12 and older and the one from Moderna for those ages 18 and older. It’s important to know that you can get both the COVID-19 booster and the flu shot simultaneously and that they won’t interfere with each other, even if you have heart disease or are on heart medication, according to Rizzo. “There are no increased side effects if you get them on the same day,” he says. “They can both give people a little bit of soreness in the arm and things like that, but there are no increased complications.” Also, Sanchez suggests that if rates of the flu are particularly high in your area, you may want to wear a mask and avoid being indoors with other people as much as possible, in addition to getting the flu shot. And as always, washing your hands frequently is one of the best ways to avoid the virus. Unsure what the risk of contracting the flu is in your area? The CDC has a flu dashboard that you can check for trends and data. This is the third time the American Heart Association, American Diabetes Association, and American Lung Association have had a joint press release or conference on this issue — because, given how the flu can affect the body in various ways, it is not necessarily under one organization’s purview alone.
