Influenza vaccination in secondary prevention: an opportunity missed.

Purpose: Influenza vaccination (FluVacc) has been added as a class I recommendation in the 2006 American Heart Association/American College of Cardiology Secondary Prevention Guidelines. Little is known about prevalence and correlates of FluVacc among patients with coronary heart disease enrolled in cardiac rehabilitation.

Methods: Data from patients with coronary heart disease enrolled in an academic medical center cardiac rehabilitation program from January 1996 through March 2006 (n = 1,051) were analyzed. The proportions of patients reporting receipt of FluVacc were compared between groups categorized by age (<65 vs 65+ years), sex, race/ethnicity, cardiovascular risk factors, comorbidities, and other clinical characteristics. Multivariate logistic regression modeling was used to determine independent correlates of FluVacc.

Results: Mean age was 60 +/- 11 years (39%, > or =65 years), 32% were women, 33% nonwhite, 37% had diabetes, 20% smoked, 12% had chronic obstructive pulmonary disease, and 52% reported up-to-date FluVacc. Independent correlates of FluVacc included older age (odds ratio 2.7 [95% confidence interval: 1.9, 3.7], P < .0001), white race (odds ratio 1.5 [95% confidence interval: 1.1, 2.0], P = .018), diabetes (odds ratio 2.2 [95% confidence interval: 1.7, 3.0], P < .0001), and chronic obstructive pulmonary disease (odds ratio 1.8 [95% confidence interval: 1.2, 2.9], P = .011).

Conclusions: Influenza vaccination rates among patients with coronary heart disease enrolled in cardiac rehabilitation are suboptimal overall, but particularly low for younger, nonwhite patients without diabetes or chronic obstructive pulmonary disease. Interventions designed to increase the rate of FluVacc are needed to improve outcomes among patients with coronary heart disease enrolled in cardiac rehabilitation.