Association of RSV Vaccination With Clinical Outcomes in Older Adults With Heart Failure: A Propensity‐Matched Analysis

Abstract

ABSTRACT Background Respiratory syncytial virus (RSV) is increasingly recognized as a trigger for adverse outcomes in older adults with heart failure (HF). Following FDA approval of RSV vaccines for adults ≥ 60 years in 2023, real‐world evidence in HF populations remains limited. Methods We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network. Adults ≥ 60 years with HF were identified and stratified by RSV vaccination status from May 1, 2023, to January 01, 2026. Propensity score matching (1:1) was performed. The primary outcome was all‐cause mortality. Secondary outcomes included respiratory failure, healthcare utilization, and cardiovascular events. Results After PSM, 777 vaccinated and 777 unvaccinated HF patients were analyzed. All‐cause mortality (HR 0.51, 95% CI, 0.33−0.79) and ICU admissions were significantly lower in vaccinated patients (2.7% vs. 5.8%, HR 0.46, 95% CI 0.25–0.86), while healthcare utilization was significantly higher in the vaccinated cohort (HR 1.85, 95% CI 1.65–2.08). No significant differences were observed in respiratory failure (7.3% vs. 9.4%, HR 0.87, 95% CI 0.61–1.23), inpatient or emergency visits (29.9% vs. 35.1%, HR 0.97, 95% CI 0.81–1.16), HF exacerbations, myocardial infarction, or stroke. Age‐stratified subgroup analyses (60–75 and 75–90 years) showed consistent findings, with no significant cardiovascular differences and significantly higher healthcare utilization in vaccinated patients across both age groups. Conclusions In older adults with HF, RSV vaccination was associated with lower mortality and fewer ICU admissions, without a corresponding reduction in overall inpatient/emergency use or acute‐care utilization. These findings are hypothesis‐generating and may reflect prevention of severe respiratory illness.