Vaccination in patients with heart failure in practice.

Publication date: Jun 25, 2025

This narrative review underscores the pivotal role of vaccination in mitigating respiratory infections and associated acute decompensations in heart failure (HF) patients. It highlights the necessity for heightened awareness and proactive engagement among healthcare providers to bridge vaccination gaps and enhance preventive care for HF patients. Respiratory pathogens, such as influenza, pneumococcus, SARS-CoV2, and Herpes zoster virus (VZV), instigate systemic inflammation and increase cardiovascular events, markedly elevating the risk of HF and strokes, especially in individuals with preexisting conditions. Respiratory infections further amplify the risk of thrombotic events in HF patients through mechanisms involving a heightened procoagulant status due to inflammation. Systemic inflammation often accompanies HF, contributing to its progression, complications, and acute episodes, particularly during respiratory infections. While promising therapeutic approaches are under development, the review aims to provide a comprehensive overview of the pathophysiology linking inflammation, infection, and HF. The review then explores current clinical knowledge on the protective effects of vaccines against respiratory diseases (influenza, pneumococcal infection, SARS-CoV2, RSV, and emerging pathogens) in HF patients, along with the key applicable guidelines. It also offers strategies to enhance vaccination coverage in HF patients, highlighting practical issues pertinent to daily clinical practice.

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