tetano
Editor, Senior Moderator
Eur Heart J
. 2026 Jul 11:ehag543.
doi: 10.1093/eurheartj/ehag543. Online ahead of print.
Influenza vaccination, incident atrial fibrillation, and cardiovascular outcomes
Laurent Fauchier[SUP] 1 [/SUP], Mickael Guglieri[SUP] 1 [/SUP], Thibault Lenormand[SUP] 1 [/SUP], Arnaud Bisson[SUP] 1 [/SUP], Gregory Y H Lip[SUP] 2 3 4 [/SUP]
Affiliations
Background and aims: Influenza infection triggers cardiovascular events, and vaccination confers cardiovascular benefit in high-risk populations. Its role in preventing incident atrial fibrillation (AF) and cardiovascular outcomes in clinical practice remains uncertain. These associations were evaluated using a real-world target-trial emulation framework.
Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Federated Research Data Network including adults with a routine healthcare visit in 2022. Influenza vaccination within the preceding year defined exposure; comparators had no recorded vaccination. A 1:1 propensity score matching across 65 baseline variables was applied. Outcomes included incident AF, cardiovascular events, and mortality, with subgroup analyses by age and baseline cardiovascular disease.
Results: After matching, 276 888 patients (138 444 per group) were included with excellent covariate balance. During a mean follow-up of 2.7 ± 0.7 years, influenza vaccination was associated with a significantly lower risk of incident AF [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.76-0.84; P < .0001]. The absolute annualized incidence of AF was 0.9% in vaccinated patients vs 1.1% in non-vaccinated patients. Vaccinated patients also had lower risks of all-cause mortality (HR 0.85, 95% CI 0.82-0.89), myocardial infarction (HR 0.91, 95% CI 0.86-0.97), incident heart failure (HR 0.92, 95% CI 0.88-0.96), and cardiovascular-related hospitalization (HR 0.97, 95% CI 0.95-0.99). Associations were directionally consistent across age and cardiovascular disease subgroups, without significant effect modification.
Conclusions: In a large retrospective observational real-world cohort, influenza vaccination was associated with lower risks of incident AF and multiple cardiovascular outcomes. These findings support vaccination as a potential upstream strategy for AF prevention and highlight the need for randomized trials specifically designed to address AF-related outcomes.
Keywords: Atrial fibrillation; Cardiovascular outcomes; Influenza vaccination.
. 2026 Jul 11:ehag543.
doi: 10.1093/eurheartj/ehag543. Online ahead of print.
Influenza vaccination, incident atrial fibrillation, and cardiovascular outcomes
Laurent Fauchier[SUP] 1 [/SUP], Mickael Guglieri[SUP] 1 [/SUP], Thibault Lenormand[SUP] 1 [/SUP], Arnaud Bisson[SUP] 1 [/SUP], Gregory Y H Lip[SUP] 2 3 4 [/SUP]
Affiliations
- PMID: 42431720
- DOI: 10.1093/eurheartj/ehag543
Background and aims: Influenza infection triggers cardiovascular events, and vaccination confers cardiovascular benefit in high-risk populations. Its role in preventing incident atrial fibrillation (AF) and cardiovascular outcomes in clinical practice remains uncertain. These associations were evaluated using a real-world target-trial emulation framework.
Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Federated Research Data Network including adults with a routine healthcare visit in 2022. Influenza vaccination within the preceding year defined exposure; comparators had no recorded vaccination. A 1:1 propensity score matching across 65 baseline variables was applied. Outcomes included incident AF, cardiovascular events, and mortality, with subgroup analyses by age and baseline cardiovascular disease.
Results: After matching, 276 888 patients (138 444 per group) were included with excellent covariate balance. During a mean follow-up of 2.7 ± 0.7 years, influenza vaccination was associated with a significantly lower risk of incident AF [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.76-0.84; P < .0001]. The absolute annualized incidence of AF was 0.9% in vaccinated patients vs 1.1% in non-vaccinated patients. Vaccinated patients also had lower risks of all-cause mortality (HR 0.85, 95% CI 0.82-0.89), myocardial infarction (HR 0.91, 95% CI 0.86-0.97), incident heart failure (HR 0.92, 95% CI 0.88-0.96), and cardiovascular-related hospitalization (HR 0.97, 95% CI 0.95-0.99). Associations were directionally consistent across age and cardiovascular disease subgroups, without significant effect modification.
Conclusions: In a large retrospective observational real-world cohort, influenza vaccination was associated with lower risks of incident AF and multiple cardiovascular outcomes. These findings support vaccination as a potential upstream strategy for AF prevention and highlight the need for randomized trials specifically designed to address AF-related outcomes.
Keywords: Atrial fibrillation; Cardiovascular outcomes; Influenza vaccination.