What is the reason for and aim of the publication?
This annual publication is designed to provide guidance to cardiology clinicians regarding vaccinations along with more detailed justifications for those interested in the evidence underlying these recommendations. Research shows that patients are considerably more likely to be vaccinated when their physician or healthcare team recommends vaccination.
What are the most important take-home messages?
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Respiratory viral infections are associated with increased cardiovascular events. Patients with heart disease face a higher risk of adverse outcomes, including hospitalization and death, following respiratory viral infection compared with the general population. Additionally, the likelihood of infection after exposure may be higher in this population.
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Vaccination can reduce CV events. Observational studies are consistent with randomized trials demonstrating lower hospitalization and death rates among vaccinated individuals.
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Adverse health effects associated with vaccination are exceedingly rare and are far outweighed by the benefits, particularly in patients with heart disease.
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Cardiology clinics provide an important opportunity for vaccination.
Figure: Evidence for Respiratory Vaccine Benefit
AUSPICE = Australian Study for the Prevention Through Immunisation of Cardiovascular Events; CV = cardiovascular; DANFLU-2 = Danish Influenza Vaccination Trial 2; DAN-RSV = Danish RSV Vaccination Trial; FLUNITY-HD = Fluenza Vaccinate High Dose; IAMI = Influenza Vaccination After Myocardial Infarction; HF = heart failure; IAMI = Influenza Vaccination After Myocardial Infarction; MI = myocardial infarction; RCT = randomized controlled trial; RSV = respiratory syncytial virus.
What are the challenges in practical implementation – and possible solutions?
Many cardiology clinics do not provide vaccination, and cardiology clinicians may not remember the current recommendations for vaccination. This document can reduce any reluctance to recommend and provide vaccination.
Responses to frequently asked questions from patients who may be hesitant about vaccination:
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- Should I be concerned about serious side effects?
Serious side effects are exceedingly rare, and for patients with heart disease, the benefits of reduced severe disease with vaccination far outweigh the small risk of side effects.
- What about myocarditis?
Myocarditis occurs rarely as a side effect of COVID-19 vaccines (mRNA type), with up to 70 cases in 100,000 vaccinations and occurs primarily among adolescent males and young men. The severity is typically mild and almost always temporary.
- Is there danger to patients with heart disease in receiving multiple vaccines at once?
No. In fact, there may be improved efficiency from receiving multiple vaccines on the same day. However, for those requiring 2 pneumococcal vaccines (PCV15 and PPSV23), these should not be given at the same time.
- Is vaccination safe in pregnancy?
Yes. Pregnant patients, with or without heart disease, are encouraged to be vaccinated.
Which issues still need to be tackled that are not yet addressed by the paper?
This paper covers the current evidence for treatment and implementation. Additional studies are needed to determine the most cost-effective methods of encouraging vaccination.
What further developments on the topic are emerging?
New vaccinations are about to be released (e.g. mRNA vaccine for influenza) and thus the recommendations will need to be updated frequently.
Adult Immunizations as Part of Cardiovascular Care
Heidenreich PA, Bhatt A, Nazir NT, Schaffner W, Vardeny O. Adult Immunizations as Part of Cardiovascular Care: 2026 ACC Concise Clinical Guidance: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Published online August 5, 2026. doi:10.1016/j.jacc.2026.07.004
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