Should heart patients get the flu vaccine?

by Carolyn Thomas   ♥  @HeartSisters

People with heart disease have a harder time coping with the flu than people without heart disease. This is because the influenza virus produces significant stress on the cardiovascular system – breathing difficulty, changes in blood pressure, rapid heart rate, and even direct effects on the heart – that make this illness particularly difficult and even dangerous for anyone who has heart disease.

That’s why I went for my flu vaccine this morning at my local health clinic. In fact, I had two flu shots today, one in each arm: one for the pandemic H1N1 influenza, and one for Influenza A&B, the ‘normal’ seasonal flu.  I was assessed as a high priority flu shot recipient because I’m under the age of 65 with a heart condition – just barely ahead of the NHL’s Calgary Flames and Toronto Maple Leafs hockey teams whose players are apparently (who knew?) in a very high risk and high priority group, too, right up there with heart attack survivors.

Whoever we are, getting hit by the flu is no picnic, as described in this love letter from your flu bug:

“I want you.
I shall seek and find you.
I shall take you to bed and have my way with you.
I will make you ache, shake and sweat till you moan and groan.
I will make you beg for mercy.
I will exhaust you to the point that you will be relieved when I’m finished with you, and you will be weak for days.”

All my love, 

H1N1

The strongest evidence for protection from a flu shot in those with heart disease comes from the Flu Vaccination in Acute Coronary Syndromes study. Researchers followed patients who had been hospitalized for either a heart attack or a planned angioplasty, half of whom were randomly assigned to receive a flu vaccine and half remained unvaccinated. Over the next year, twice as many of the unvaccinated group (23%) died of heart disease, had a non-fatal heart attack, or developed severe ischemia (insufficient blood supply to the heart tissue), compared with those who were vaccinated (11%).  

According to retired cardiologist Dr. Richard Fogoros, “If you have heart disease, the garden variety flu is bad enough. Worse, because H1N1 or ‘swine flu’ is a very new strain of influenza, your chances of getting quite sick if you are exposed to it are probably higher than with normal influenza. So you must take at least the same precautions you ought to take during any flu season.” 

Dr. Fogoros joins most physicians in recommending one important precaution heart patients should take every year: get your flu shot, particularly this year if you are under the age of 65 and have heart disease or any other chronic condition. “Influenza vaccines reduce the risk of dying if you have heart disease, and there is every reason to believe that the H1N1 flu shot will also reduce the risk of death. If you have heart disease, you should get the H1N1 flu shot as soon as it is available to you. This means that this year you should get two flu shots – one for H1N1, and one “regular” seasonal flu shot for the “normal” flu.” Find out more from Canada’s Public Health Agency about why those with a chronic medical condition like heart disease should get a flu shot.

Even in cardiac circles, however, there remains some debate about whether or not vulnerable heart patients should get vaccinated.  Such debate is not news to historian Michael Bliss, author of the 1991 book Plague: When Smallpox Devastated Montreal. “The idea of ingesting a sometimes toxic foreign substance is not intuitively acceptable to many,” he writes in the Globe and Mail.

“In 1885, public health officials in Montreal, then Canada’s largest city, tried to stop an outbreak of smallpox by offering extensive public vaccination. 

“There was a tradition of suspicion about vaccination in Quebec, a tendency to take smallpox for granted as one of the many diseases sent by God to punish sinners. Fear of the vaccine became greater than fear of smallpox. With vaccination suspended or resisted, the virus spread like wildfire among unvaccinated Montreal children, and within a few months caused 3,000 of them to die horribly, unnecessarily. Observers wrote at the time that fear, ignorance and fatalism had trumped common sense and good medical judgement.  There had been rioting in Montreal’s streets when the Board of Health tried to make vaccination compulsory.

Pulitzer Prize-winning American historian Dr. David M. Oshinsky compares what’s been called the current pandemic doublethink with two previous situations.

“In 1947, a man newly arrived in New York City from Mexico died of smallpox. The authorities lined up the entire city and vaccinated everyone, even those who had already been vaccinated.

“The entire city was re-vaccinated and there was no real resistance. People had a sense of risk versus reward, and they listened to public health officials.

“Then there were the polio vaccine trials of 1954, in which parents volunteered more than a million children to receive either an experimental vaccine or a placebo. And while they trusted the medical profession much more than parents do now, there was another factor: they also had lived through virulent epidemics. That to me is probably the biggest issue of all. You’re dealing with people today who have never seen a smallpox epidemic or a polio epidemic.”

Whatever heart patients now decide about getting vaccinated, there are two other easy flu season precautions we should all be implementing: wash your hands regularly with hot water and soap, and don’t shake hands.  Yes, you read that right. A handshake is a great way to transmit viruses and bacteria from person to person.  At our Toastmasters meetings, for example, we’ve started doing small bows to each other instead of shaking hands in flu season. Watch these creative examples of other handshaking alternatives from NPR.

Still unsure if you should get the flu vaccine?  

Get help deciding from Mayo Clinic experts with the answers to flu-related issues, such as:

• How serious is the global threat of swine flu (H1N1)?
• Germs: Understand and protect against bacteria, viruses and infection
• Influenza (flu)
• Common cold
• Flu shot: Your best bet for avoiding influenza
• Flu school closing: Any benefit?
• Vaccines for adults
• Hand washing: An easy way to prevent infection
• Disaster planning: Things you can do to stay healthy
• Bird flu (avian influenza)
• Swine flu (H1N1 flu)

See also:

•  How Long Can Flu Bugs Survive on That Doorknob? 
•  Texas Heart Institute Journal – the Flu Vaccination in Acute Coronary Syndromes follow-up study published in 2004
• The Globe and Mail essay on the book, Plague: When Smallpox Devastated Montreal
• The Huffington Post essay by Dr. Larry Brilliant called: “Love In The Time of Swine Flu”

© 2009 Heart Sisters   Carolyn Thomas   www.heartsisters.org

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