SARS-CoV-2 vaccine hesitancy in patients with heart failure: relationship with patient characteristics and pre-pandemic quality of life – a cohort study

Filip Sawczak; Agata Kukfisz; Maria Cierzniak; Alicja Szubarga; Aleksandra Soloch; Anita Balewska; Magdalena Szczechla; Helena Krysztofiak; Katarzyna Przytarska; Magdalena Dudek; Izabella Uchmanowicz; Ewa Straburzyńska-Migaj; Marta Kałużna-Oleksy

doi:10.20883/medical.e883

Authors

Filip Sawczak 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0003-3449-8751
Agata Kukfisz 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0001-9424-8004
Maria Cierzniak 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0002-1881-5086
Alicja Szubarga 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0002-6215-7148
Aleksandra Soloch 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0002-7410-190X
Anita Balewska 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0001-7472-478X
Magdalena Szczechla 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0002-7307-4460
Helena Krysztofiak Department of Cardiology, University Hospital in Opole, Poland https://orcid.org/0000-0003-0748-9059
Katarzyna Przytarska 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0001-6985-3640
Magdalena Dudek 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0001-6550-6182
Izabella Uchmanowicz Faculty of Health Sciences, Wroclaw Medical University, Poland https://orcid.org/0000-0001-5452-0210
Ewa Straburzyńska-Migaj 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0002-0545-3370
Marta Kałużna-Oleksy 1st Department of Cardiology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0003-4048-6247

DOI:

https://doi.org/10.20883/medical.e883

Keywords:

COVID-19, quality of life, heart failure, vaccination, vaccination hesitancy, cardiovascular disease, age

Abstract

Heart failure (HF) patients are vulnerable to a complicated course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This research analysed the relationship between the decision not to be immunised against SARS-CoV-2, clinical and epidemiological factors, and the pre-pandemic health-related quality of life (HRQoL) of HF patients. Before the onset of the SARS-CoV-2 pandemic, hospitalised HF patients were enrolled as a prospective cohort and interviewed using the World Health Organization's Quality of Life Brief Version questionnaire. On October 30, 2021, the immunisation status was verified. The association of vaccination hesitancy with epidemiological and clinical parameters and pre-pandemic questionnaire results was tested. Subsequently, independence from confounding factors such as age, sex, the New York Heart Association (NYHA) scale, and left ventricular ejection fraction (LVEF) was analyzed. Among the 136 included patients, 77.9% were vaccinated. Unvaccinated patients were younger (51.2±13.2 vs 56.6±10.3; p = 0.018) and more frequently had non-ischaemic aetiology of HF (73.3% vs 46.7%; p=0.013). It was significant after adjustment for age, sex, NYHA class, and LVEF. There was no association of overall HRQoL or domain scores with vaccination status. Younger age as a factor associated with vaccine avoidance in this population is consistent with data from the general population despite higher exposure to the severe course of the disease.

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References

Chen PZ, Bobrovitz N, Premji Z, Koopmans M, Fisman DN, Gu FX. Heterogeneity in Transmissibility and Shedding SARS-CoV-2 via Droplets and Aerosols. Elife. 2021;10:e65774. doi: 10.7554/eLife.65774. DOI: https://doi.org/10.7554/eLife.65774

Richard M, Kok A, de Meulder D, Bestebroer TM, Lamers MM, Okba NMA, Fentener van Vlissingen M, Rockx B, Haagmans BL, Koopmans MPG, et al. SARS-CoV-2 Is Transmitted via Contact and via the Air between Ferrets. Nat Commun. 2020;11:3496. doi: 10.1038/s41467-020-17367-2. DOI: https://doi.org/10.1038/s41467-020-17367-2

WHO Coronavirus (COVID-19) Dashboard Available online: https://covid19.who.int (accessed on 19 December 2022).

EMA EMA Recommends First COVID-19 Vaccine for Authorisation in the EU Available online: https://www.ema.europa.eu/en/news/ema-recommends-first-covid-19-vaccine-authorisation-eu (accessed on 19 December 2022).

Liu Q, Qin C, Liu M, Liu J. Effectiveness and Safety of SARS-CoV-2 Vaccine in Real-World Studies: A Systematic Review and Meta-Analysis. Infectious Diseases of Poverty. 2021;10:132. doi: 10.1186/s40249-021-00915-3. DOI: https://doi.org/10.1186/s40249-021-00915-3

Yiannakoulias N, Slavik CE, Chase M. Expressions of Pro- and Anti-Vaccine Sentiment on YouTube. Vaccine. 2019;37:2057–2064. doi: 10.1016/j.vaccine.2019.03.001. DOI: https://doi.org/10.1016/j.vaccine.2019.03.001

Shelby A, Ernst K. Story and Science. Human Vaccines & Immunotherapeutics. 2013;9:1795–1801. doi: 10.4161/hv.24828. DOI: https://doi.org/10.4161/hv.24828

Kestenbaum LA, Feemster KA. Identifying and Addressing Vaccine Hesitancy. Pediatric Annals. 2015;44:e71–e75. doi: 10.3928/00904481-20150410-07. DOI: https://doi.org/10.3928/00904481-20150410-07

Wawrzuta D, Jaworski M, Gotlib J, Panczyk M. What Arguments against COVID-19 Vaccines Run on Facebook in Poland: Content Analysis of Comments. Vaccines (Basel). 2021;9:481. doi: 10.3390/vaccines9050481. DOI: https://doi.org/10.3390/vaccines9050481

Wu J, Li Q, Silver Tarimo C, Wang M, Gu J, Wei W, Ma M, Zhao L, Mu Z, Miao Y. COVID-19 Vaccine Hesitancy Among Chinese Population: A Large-Scale National Study. Frontiers in Immunology. 2021; 12. DOI: https://doi.org/10.3389/fimmu.2021.781161

Yasmin F, Najeeb H, Moeed A, Naeem U, Asghar MS, Chughtai NU, Yousaf Z, Seboka BT, Ullah I, Lin CY, Pakpour AH. COVID-19 Vaccine Hesitancy in the United States: A Systematic Review. Front Public Health. 2021 Nov 23;9:770985. doi: 10.3389/fpubh.2021.770985. DOI: https://doi.org/10.3389/fpubh.2021.770985

Willis DE, Presley J, Williams M, Zaller N, McElfish PA. COVID-19 Vaccine Hesitancy among Youth. Hum Vaccin Immunother. 2021;17:5013–5015. doi: 10.1080/21645515.2021.1989923. DOI: https://doi.org/10.1080/21645515.2021.1989923

Rosano G, Jankowska EA, Ray R, Metra M, Abdelhamid M, Adamopoulos S, Anker SD, Bayes-Genis A, Belenkov Y, Ben Gal T, et al. COVID-19 Vaccination in Patients with Heart Failure: A Position Paper of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2021;23:1806–1818. doi: 10.1002/ejhf.2356. DOI: https://doi.org/10.1002/ejhf.2356

The World Health Organization Quality of Life Assessment (WHOQOL): Position Paper from the World Health Organization. Soc Sci Med. 1995;41:1403–1409. doi: 10.1016/0277-9536(95)00112-k. DOI: https://doi.org/10.1016/0277-9536(95)00112-K

Skevington SM, Lotfy M, O’Connell KA, WHOQOL Group The World Health Organization’s WHOQOL-BREF Quality of Life Assessment: Psychometric Properties and Results of the International Field Trial. A Report from the WHOQOL Group. Qual Life Res. 2004;13:299–310. doi: 10.1023/B:QURE.0000018486.91360.00. DOI: https://doi.org/10.1023/B:QURE.0000018486.91360.00

Perera HN, Izadikhah Z, O’Connor P, McIlveen P. Resolving Dimensionality Problems With WHOQOL-BREF Item Responses. Assessment. 2018;25:1014–1025. doi: 10.1177/1073191116678925. DOI: https://doi.org/10.1177/1073191116678925

Jaracz K, Kalfoss M, Górna K, Bączyk G. Quality of Life in Polish Respondents: Psychometric Properties of the Polish WHOQOL – Bref. Scandinavian Journal of Caring Sciences. 2006;20:251–260. doi: 10.1111/j.1471-6712.2006.00401.x. DOI: https://doi.org/10.1111/j.1471-6712.2006.00401.x

WHOQOL-BREF : Introduction, Administration, Scoring and Generic Version of the Assessment : Field Trial Version, December 1996 Available online: https://www.who.int/publications-detail-redirect/WHOQOL-BREF (accessed on 19 December 2022).

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, et al. 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. Eur Heart J. 2021;42:3599–3726. doi: 10.1093/eurheartj/ehab368. DOI: https://doi.org/10.1093/eurheartj/ehab368

Gaur P, Agrawat H, Shukla A. COVID-19 Vaccine Hesitancy in Patients with Systemic Autoimmune Rheumatic Disease: An Interview-Based Survey. Rheumatol Int. 2021;41:1601–1605. doi: 10.1007/s00296-021-04938-9. DOI: https://doi.org/10.1007/s00296-021-04938-9

Kumari A, Ranjan P, Chopra S, Kaur D, Kaur T, Upadhyay AD, Isaac JA, Kasiraj R, Prakash B, Kumar P, et al. Knowledge, Barriers and Facilitators Regarding COVID-19 Vaccine and Vaccination Programme among the General Population: A Cross-Sectional Survey from One Thousand Two Hundred and Forty-Nine Participants. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021;15:987–992. doi: 10.1016/j.dsx.2021.04.015. DOI: https://doi.org/10.1016/j.dsx.2021.04.015

Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, Kimball S, El-Mohandes A. A Global Survey of Potential Acceptance of a COVID-19 Vaccine. Nat Med. 2021;27:225–228. doi: 10.1038/s41591-020-1124-9. DOI: https://doi.org/10.1038/s41591-020-1124-9

Walkowiak MP, Domaradzki J, Walkowiak D. Are We Facing a Tsunami of Vaccine Hesitancy or Outdated Pandemic Policy in Times of Omicron? Analyzing Changes of COVID-19 Vaccination Trends in Poland. Vaccines. 2023;11:1065. doi: 10.3390/vaccines11061065. DOI: https://doi.org/10.3390/vaccines11061065

Jach Ł, Lamża Ł, Wardawy P. Psychologiczne korelaty postaw wobec szczepionek na COVID-19 wśród polskich respondentów – migawkowe badanie przed rozpoczęciem masowej kampanii szczepień. Przegląd Psychologiczny. 2021;64:7–26. doi: 10.31648/pp.7351. DOI: https://doi.org/10.31648/pp.7328

Moccia G, Carpinelli L, Savarese G, De Caro F. Vaccine Hesitancy and the Green Digital Pass: A Study on Adherence to the Italian COVID-19 Vaccination Campaign. International Journal of Environmental Research and Public Health. 2022;19:2970. doi: 10.3390/ijerph19052970. DOI: https://doi.org/10.3390/ijerph19052970

Nguyen KH. COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among Groups Prioritized for Early Vaccination — United States, September and December 2020. MMWR Morb Mortal Wkly Rep. 2021; 70. doi: 10.15585/mmwr.mm7006e3. DOI: https://doi.org/10.15585/mmwr.mm7006e3

Ruiz JB, Bell RA. Predictors of Intention to Vaccinate against COVID-19: Results of a Nationwide Survey. Vaccine. 2021;39:1080–1086. doi: 10.1016/j.vaccine.2021.01.010. DOI: https://doi.org/10.1016/j.vaccine.2021.01.010

Robinson E, Jones A, Lesser I, Daly M. International Estimates of Intended Uptake and Refusal of COVID-19 Vaccines: A Rapid Systematic Review and Meta-Analysis of Large Nationally Representative Samples. Vaccine. 2021;39:2024–2034. doi: 10.1016/j.vaccine.2021.02.005. DOI: https://doi.org/10.1016/j.vaccine.2021.02.005

Cascini F, Pantovic A, Al-Ajlouni Y, Failla G, Ricciardi W. Attitudes, Acceptance and Hesitancy among the General Population Worldwide to Receive the COVID-19 Vaccines and Their Contributing Factors: A Systematic Review. eClinicalMedicine. 2021;40. doi: 10.1016/j.eclinm.2021.101113. DOI: https://doi.org/10.1016/j.eclinm.2021.101113

O’Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J, Fontanet A, Cauchemez S, Salje H. Age-Specific Mortality and Immunity Patterns of SARS-CoV-2. Nature. 2021;590:140–145. doi: 10.1038/s41586-020-2918-0. DOI: https://doi.org/10.1038/s41586-020-2918-0

Gao Y, Ding M, Dong X, Zhang J, Kursat Azkur A, Azkur D, Gan H, Sun Y, Fu W, Li W, et al. Risk Factors for Severe and Critically Ill COVID-19 Patients: A Review. Allergy. 2021;76:428–455. doi: 10.1111/all.14657. DOI: https://doi.org/10.1111/all.14657

Butt AA, Nafady-Hego H, Chemaitelly H, Abou-Samra A.-B.; Khal AA, Coyle PV, Kanaani ZA, Kaleeckal AH, Latif AN, Masalmani YA, et al. Outcomes Among Patients with Breakthrough SARS-CoV-2 Infection After Vaccination. Int J Infect Dis. 2021;110:353–358. doi: 10.1016/j.ijid.2021.08.008. DOI: https://doi.org/10.1016/j.ijid.2021.08.008

Schaler L, Wingfield M. COVID-19 Vaccine — Can It Affect Fertility? Ir J Med Sci. 2022;191:2185–2187. doi: 10.1007/s11845-021-02807-9. DOI: https://doi.org/10.1007/s11845-021-02807-9

Mohan S, Reagu S, Lindow S, Alabdulla M. COVID-19 Vaccine Hesitancy in Perinatal Women: A Cross Sectional Survey. Journal of Perinatal Medicine. 2021;49:678–685. doi: 10.1515/jpm-2021-0069. DOI: https://doi.org/10.1515/jpm-2021-0069

Galliford N, Furnham A. Individual Difference Factors and Beliefs in Medical and Political Conspiracy Theories. Scandinavian Journal of Psychology. 2017;58:422–428. doi: 10.1111/sjop.12382. DOI: https://doi.org/10.1111/sjop.12382

Patone M, Mei XW, Handunnetthi L, Dixon S, Zaccardi F, Shankar-Hari M, Watkinson P, Khunti K, Harnden A, Coupland CAC, et al. Risks of Myocarditis, Pericarditis, and Cardiac Arrhythmias Associated with COVID-19 Vaccination or SARS-CoV-2 Infection. Nat Med. 2022;28:410–422. doi: 10.1038/s41591-021-01630-0. DOI: https://doi.org/10.1038/s41591-021-01630-0

Oster ME, Shay DK, Su JR, Gee J, Creech CB, Broder KR, Edwards K, Soslow JH, Dendy JM, Schlaudecker E, et al. Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021. JAMA. 2022;327:331–340. doi: 10.1001/jama.2021.24110. DOI: https://doi.org/10.1001/jama.2021.24110

Patone M, Mei XW, Handunnetthi L, Dixon S, Zaccardi F, Shankar-Hari M, Watkinson P, Khunti K, Harnden A, Coupland CAC, et al. Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex. Circulation. 2022;146:743–754. doi: 10.1161/CIRCULATIONAHA.122.059970. DOI: https://doi.org/10.1161/CIRCULATIONAHA.122.059970

Lin C.-Y.; Fan C.-W.; Ahorsu DK, Lin YC, Weng H.-C.; Griffiths MD. Associations between Vaccination and Quality of Life among Taiwan General Population: A Comparison between COVID-19 Vaccines and Flu Vaccines. Human Vaccines & Immunotherapeutics. 2022;18:2079344. doi: 10.1080/21645515.2022.2079344. DOI: https://doi.org/10.1080/21645515.2022.2079344

Wu Q, Shen Y, Xie L, Zhang J, Qiu Z, Tang M, Chen L. Low acceptance rate of COVID-19 vaccination and reduced quality of life among heart transplant recipients during the COVID-19 pandemic. J Card Surg. 2022 Dec;37(12):4975-4981. doi: 10.1111/jocs.17205. Epub 2022 Nov 29. DOI: https://doi.org/10.1111/jocs.17205

Babicki M, Malchrzak W, Hans-Wytrychowska A, Mastalerz-Migas A. Impact of Vaccination on the Sense of Security, the Anxiety of COVID-19 and Quality of Life among Polish. A Nationwide Online Survey in Poland. Vaccines. 2021;9:1444. doi: 10.3390/vaccines9121444. DOI: https://doi.org/10.3390/vaccines9121444

Zintel S, Flock C, Arbogast AL, Forster A, von Wagner C, Sieverding M. Gender Differences in the Intention to Get Vaccinated against COVID-19: A Systematic Review and Meta-Analysis. Z Gesundh Wiss. 2022; 1–25. doi: 10.1007/s10389-021-01677-w. DOI: https://doi.org/10.2139/ssrn.3803323

Bartosiewicz A, Łuszczki E, Bartosiewicz A, Dereń K, Oleksy Ł, Stolarczyk A. COVID-19-Related Predictors of Fear and Attitude to Vaccination Displayed by Polish Students. Vaccines (Basel). 2022;10:1524. doi: 10.3390/vaccines10091524. DOI: https://doi.org/10.3390/vaccines10091524

Jain J, Saurabh S, Kumar P, Verma MK, Goel AD, Gupta MK, Bhardwaj P, Raghav PR. COVID-19 Vaccine Hesitancy among Medical Students in India. Epidemiology & Infection. 2021;149:e132. doi: 10.1017/S0950268821001205. DOI: https://doi.org/10.1017/S0950268821001205

Marziali E, Lontano A, Regazzi L, Paladini A, Villani L, Calabrò GE, Damiani G, Laurenti P, Ricciardi W, Cadeddu C. Factors Influencing the Choice to Advise for or against COVID-19 Vaccination in the Physicians and Dentists of an Italian Region. Vaccines. 2022;10:1793. doi: 10.3390/vaccines10111793. DOI: https://doi.org/10.3390/vaccines10111793

Williams L, Gallant AJ, Rasmussen S, Brown Nicholls LA, Cogan N, Deakin K, Young D, Flowers P. Towards Intervention Development to Increase the Uptake of COVID-19 Vaccination among Those at High Risk: Outlining Evidence-Based and Theoretically Informed Future Intervention Content. British Journal of Health Psychology. 2020;25:1039–1054. doi: 10.1111/bjhp.12468. DOI: https://doi.org/10.1111/bjhp.12468

Al-Metwali BZ, Al-Jumaili AA, Al-Alag ZA, Sorofman B. Exploring the Acceptance of COVID-19 Vaccine among Healthcare Workers and General Population Using Health Belief Model. Journal of Evaluation in Clinical Practice. 2021;27:1112–1122. doi: 10.1111/jep.13581. DOI: https://doi.org/10.1111/jep.13581

Risma KA. COVID-19 mRNA Vaccine Allergy. Curr Opin Pediatr. 2021;33:610–617. doi: 10.1097/MOP.0000000000001077. DOI: https://doi.org/10.1097/MOP.0000000000001077