Heart Failure, AF, and Mortality More Common After RSV Than UTI or Flu Hospitalizations in Older Adults

Respiratory syncytial virus (RSV) hospitalizations led to poorer outcomes and a higher risk of cardiovascular events than influenza, urinary tract infection (UTI) or fracture hospitalizations in older adults.¹

“Unlike other respiratory viruses, immunity against RSV tends to decline relatively quickly. This means that a previous infection will not afford the same long-term protection as it might for influenza or COVID-19,” corresponding author Chris Verschoor, PhD, HSN, Foundation Research Chair in Healthy Aging at Health Sciences North Research Institute, said in a statement.² “Our findings reinforce the importance of RSV vaccination in older adults and suggest that monitoring for signs of heart disease following an RSV illness may be pragmatic.”

Verschoor and colleagues conducted a retrospective cohort study of adults aged at least 65 years hospitalized with a diagnosis of RSV, influenza, UTI, or fracture between 2011 and 2020 in Ontario, Canada. They measured outcomes including subsequent heart failure, myocardial infarction, stroke, or atrial fibrillation (AF) events up to 1-year post-discharge, as well as in-hospital and acute outcomes.

The investigators identified cardiovascular events in 18.5% (n = 474/2558) of patients who had an RSV-related hospitalization, compared to 17.7% (n = 2961/16,688), 12.1% (n = 8908/73,587), and 8.4% (n = 941/11,262) of patients initially hospitalized with influenza, UTI, or fracture, respectively.¹

They conducted matched analyses which revealed that RSV hospitalization was associated with a greater rate of subsequent heart failure events relative to influenza (HR, 1.65; 95% CI, 1.14–2.38), UTI (HR, 1.92; 95% CI, 1.28–2.88) and fracture (HR, 1.81; 95% CI, 1.41–2.31) hospitalizations.¹

This was similar for those without a pre-existing cardiovascular condition and those with at least 1, although differences between RSV and influenza were not significant (HR, 1.42; 95% CI, 0.93–2.16 and HR, 1.02; 95% CI, 0.83–1.25, respectively) in those with at least 1. In these patients, Hazards were significant when compared to UTI (HR, 2.51; 95% CI, 1.52–4.15 and HR, 1.48; 95% CI, 1.19–1.85, respectively) and fracture (HR, 3.74; 95% CI, 1.97–7.08 and HR, 1.56; 95% CI, 1.14–2.14).¹

Patients hospitalized for RSV also had a higher rate of AF compared to those hospitalized for fracture (HR, 1.50; 95% CI, 1.08–2.08). In those without a pre-existing cardiovascular condition, the rate in patients with RSV was 2.61 (95% CI, 1.29–4.91) times higher than those with UTI and 2.29 (95% CI, 1.14–4.58) times higher than those with fracture. Patients with RSV also had higher rates of stroke, although the limited incidence resulted in wide confidence intervals.¹

For secondary outcomes, patients with RSV had increased 30-day mortality, higher rates of ICU admission, and longer hospital stays compared to other groups. The odds of ICU transfer were especially elevated for patients with RSV, regardless of cardiovascular history. Compared with patients who had a UTI or a fracture and no pre-existing cardiovascular conditions, the likelihood of ICU admission was significantly higher (OR, 4.63; 95% CI, 3.26–6.58 and OR, 3.75; 95% CI, 2.60–5.42, respectively). Thirty-day mortality rates were also generally elevated among patients with RSV, ranging from 1.49 to 3.98. Lengths of stay were approximately 11% to 32% longer for patients with RSV, except in the case of fracture, where stays were shorter regardless of cardiovascular status. The 30-day readmission risk was higher for patients with RSV than for those with fractures (OR, 1.36; 95% CI, 1.08–1.71), but lower than for those with UTIs (OR, 0.73; 95% CI, 0.59–0.90).¹

“In summary, our findings further substantiate the importance of RSV as a significant cause of short- and long-term health outcomes in older adults, and in particular, the rate of heart failure. Given the variable nature of RSV testing over the past two decades, we cannot conclude that our findings are generalizable to all older patients hospitalized for an RSV illness. Nonetheless, increased monitoring in-hospital and routine follow-up with older RSV patients for cardiovascular symptoms indicative of decompensation (e.g., dyspnea, arrythmia, weight gain, etc.) may be beneficial to mitigate long-term outcomes. Although RSV infections are less common than influenza in older adults, they remain a substantial source of economic burden to healthcare systems. Our findings underline the importance of robust and effective public health strategies regarding RSV vaccines,” Verschoor and colleagues concluded.¹

REFERENCES

1. Verschoor CP, Cerasuolo JO, Caswell JM, et al. Respiratory Syncytial Virus (RSV)‐Related Hospitalization and Increased Rate of Cardiovascular Events in Older Adults. J Am Ger Soc. Published online July 23, 2025. doi: 10.1111/jgs.19591

2. How does infection with respiratory syncytial virus affect the health of older adults? News release. Wiley. July 23, 2025. https://newsroom.wiley.com/press-releases/press-release-details/2025/How-does-infection-with-respiratory-syncytial-virus-affect-the-health-of-older-adults/default.aspx