• Angela Tufvesson - Hong Kong

1Q5A: Putting heart into vaccination decision-making

Myriad factors influence a patient’s decision to receive influenza vaccination, which is seen to promote cardiovascular health. The significant role of medical professionals and cardiologists, in particular, is often underestimated, explains Dr Alvaro Sosa Liprandi, head of cardiology at the Guemes Sanatorium in Buenos Aires, Argentina, and president of the Inter-American Society of Cardiology.


(PART 3 of 5) Re:solve Global Health’s latest Q&A series examines the positive association between influenza vaccination and cardiovascular health. We asked five experts in diverse locations, and from varied backgrounds, including cardiology, pharmaceuticals, and health economics, to answer this crucial question: How can we make best use of influenza vaccination to improve cardiovascular health?

What are the factors that influence vaccination decision-making?


A key limitation in effective vaccination involves complex behavioural attributes related to the psychological aspects of patients. These aspects can be grouped into complacency (low perceived risk), inconvenience (self-efficacy, cost, behavioural aspects), lack of confidence (aspects such as distrust in the efficacy and adverse effects, greater acceptance of negative myths), and calculation (individual and social risk-benefit ratio).


Sociocultural factors have also been identified, such as economic strata, education level—paradoxically, patients with the highest educational level reject vaccination to a greater extent—religion, and demographic variables.


Fake news in the media, social networks, and people who advocate against vaccination are also key aspects in the hesitation process, with potentially harmful effects on population health.


How important is the role of medical professionals in vaccination decision-making?


As with other prevention strategies, medical knowledge through continuous education, clear regulations, and conviction regarding the risk-benefit ratio seem to be the main determinants of the implementation of an intervention. When missed opportunities were analysed in unvaccinated patients, lack of recommendation during medical visits was identified as the main cause.


It is understood that physicians’ conviction seems to be more influential than the perceptions of the patient when analysing effective vaccination rates. The strong and positive attitude by the doctors at the moment of vaccine prescription seems decisive.


The implementation of continuous medical education programmes aimed at general practitioners and specialists addressing the benefits and opportunities of influenza vaccination should be considered as a primary objective, as well as its incorporation into clinical practice guidelines.


Do cardiologists typically encourage patients to receive influenza vaccination?


In the last 15 years, influenza vaccination in high-risk populations has become an effective strategy to reduce the incidence of respiratory infections and, therefore, associated cardiovascular complications. A recently published consensus document by the Inter-American Society of Cardiology and the World Heart Federation reinforces the use of the influenza vaccination in adults in order to reduce the rate of cardiovascular events and its effect on the burden of the disease.


However, the prescription of vaccination is not usual practice among cardiologists, and vaccination rates vary widely among high-risk vulnerable populations in different regions of the world. In particular, most low- and middle-income countries (LMICs) have not reached the target of a 70% vaccination rate for high-risk groups set by the World Health Organization.


How can cardiologists and coronary care units help increase influenza vaccination rates among high-risk patients?


Patients’ adherence to treatment while undergoing acute -high-mortality diseases, such as an acute coronary syndrome, is almost complete upon discharge from the coronary care unit, but drastically falls during follow-up.


Therefore, and in the light of emergent and conclusive data from the recent IAMI [influenza vaccination after myocardial infarction] trial, implementation of influenza vaccination prior to discharge or immediately after would be a highly effective measure to increase vaccination rates.

The correct understanding of implementation barriers, which involves doctors, patients, and their context, is essential when designing continuous improvement strategies to optimise the effective rate of influenza vaccination.