• Angela Tufvesson - Hong Kong

1Q5A: Why vaccination adherence is higher before discharge

Thanks to the heightened focus on vaccination during the pandemic, patients with cardiovascular disease are now more willing to receive influenza vaccination. Dr Carlos Aguiar, chair of the advanced heart failure and heart transplantation unit at Hospital Santa Cruz in Portugal, says providing vaccination in hospital settings can significantly boost uptake and outcomes.


(PART 4 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?

How have patient attitudes to influenza vaccination changed during the pandemic?


Before the pandemic, a lot of people were not keen on getting the flu vaccination. They would either say that they had never contracted flu and didn’t think they needed to be worried about it. The other reason given was that they had received a flu shot some time in the past and they never felt so ill. This did not help in my efforts to promote influenza vaccination.


Patients now believe strongly in the benefits of vaccination and the acceptability has improved significantly. And as flu vaccination and the booster shot for covid-19 can be taken at the same time, more people are going for it.


How do the facilities available for influenza vaccination potentially affect take-up rates?


In Portugal, flu vaccination can either be taken at primary care facilities, where it is given free to those who meet the criteria listed in the national guidance documents, or at a pharmacy, where it is administered by a nurse.


Crucially, regular ambulatory patients do not get the flu vaccination at a hospital. This allows the opportunity for understanding the importance of flu vaccination to get lost in between the moment when we're speaking about this at the outpatient clinic and the timing of the patient going to the primary care facility to get the shot.


The thing that is remarkable to me is that patients are keener to adhere to medications prescribed during hospital stay, than to those prescribed after discharge, when they are feeling less sick or quite well and recovered. This is largely because patients have recovered under the care of the healthcare professionals when they’re hospitalised, so they’re more likely to say ‘yes’ to their suggestions.


Why is it more beneficial for high-risk patients when the influenza vaccination is offered in hospital settings?


In a recent randomised control trial, patients in several countries who were hospitalised with an acute myocardial infarction [heart attack] got the flu shot when it was the flu season. The benefits were very strong in terms of mortality reductions.


The research shows that it is not only feasible to opportunistically administer the flu vaccine in a hospital setting, but it is also proof of concept to our cardiac patients that it is complementary to all the other medications we're giving them.


However, I am not aware of any health system that is considering putting these trial results into practice and giving flu vaccines at hospitals during the flu months. It's sad that we haven't seized the opportunity to reach out to a very vulnerable patient population that would very likely adhere at that moment.


Would offering influenza vaccination in hospital settings be cost-prohibitive?


There are significant challenges in getting flu vaccinations to hospitals and getting the vaccination done during hospitalisation. But I don't think the costs are higher, compared to current protocols of administering.


Plus, I imagine that we would be reaching out to many more people, and specifically to people who will derive significant benefits from the vaccination. This means a targeted approach can be extremely cost-effective for national health services.