Influenza vaccination and 1-year risk of myocardial infarction, stroke, heart failure, pneumonia, and mortality among intensive care unit survivors aged 65 years or older: a nationwide population-based cohort study

Intensive Care Med. 2019 Jul;45(7):957-967. doi: 10.1007/s00134-019-05648-4. Epub 2019 Jun 11.


Purpose: We examined whether influenza vaccination affects 1-year risk of myocardial infarction, stroke, heart failure, pneumonia, and death among intensive care unit (ICU) survivors aged ≥ 65 years.

Methods: Danish Intensive Care Database data on all elderly ( ≥ 65 years) patients hospitalized in Danish ICUs in the period 2005-2015, and subsequently discharged, were linked with data from other medical registries, including data on uptake of the seasonal influenza vaccine. We computed these patients' 1-year risk of hospitalization for myocardial infarction, stroke, heart failure, or pneumonia, and their 1-year risk of all-cause mortality. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using Cox proportional hazards regression, with adjustment and propensity score matching applied to handle confounding.

Results: The study included 89,818 ICU survivors. The influenza vaccinated patients (n = 34,871, 39%) were older, had more chronic diseases, and used more prescription medications than the unvaccinated patients. Adjusted 1-year mortality was decreased among the vaccinated versus the unvaccinated patients (19.3% versus 18.8%; adjusted HR, 0.92; 95% CI 0.89-0.95). Influenza vaccination was also associated with a decreased risk of stroke (adjusted HR, 0.84; 95% CI 0.78-0.92), but only a small, non-significantly decreased risk of myocardial infarction (adjusted HR, 0.93; 95% CI 0.83-1.03). There was no association between vaccination and subsequent hospitalization for heart failure or pneumonia. Propensity score matched analyses confirmed these findings.

Conclusions: Compared with the unvaccinated ICU survivors, the influenza vaccinated ICU survivors had a lower 1-year risk of stroke and a lower 1-year risk of death, whereas no substantial association was observed for the risk of hospitalization for myocardial infarction, heart failure, or pneumonia. Our findings support influenza vaccination of individuals aged ≥ 65 years.

Keywords: Cardiovascular diseases; Cohort studies; Infection; Influenza vaccines; Intensive care; Mortality.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Comorbidity
  • Denmark / epidemiology
  • Female
  • Heart Failure / epidemiology
  • Hospitalization / statistics & numerical data*
  • Humans
  • Influenza Vaccines / administration & dosage*
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Myocardial Infarction / epidemiology
  • Pneumonia / epidemiology
  • Polypharmacy
  • Proportional Hazards Models
  • Stroke / epidemiology
  • Survivors / statistics & numerical data*
  • Time Factors


  • Influenza Vaccines