These are the vaccination recommendations of American cardiologists if you have heart disease.

The American College of Cardiology has published a Concise Clinical Guideline (CCG) outlining which vaccines are recommended to protect adults with heart disease against respiratory illnesses, such as influenza, COVID-19, and RSV, as well as other conditions for which vaccination has been shown to offer cardiovascular protection benefits.

“Vaccination against communicable respiratory diseases and other serious illnesses is critical for people with heart disease, but there are barriers to ensuring people are informed about which vaccines to get, how often, and why they are important. With this document, we want to encourage clinicians to have these conversations and help their patients manage vaccination as part of a standard prevention and treatment plan,” says Dr. Paul Heidenreich, FACC member and chair of the CCG writing committee.

People with heart disease are at increased risk of infection when exposed to a respiratory virus and have a higher risk of adverse outcomes, such as hospitalization and death. Studies have shown that vaccines are highly effective at reducing these risks; however, recent research revealed that only 30% of primary care physicians assess their patients' vaccination status during clinical visits.

This guide focuses primarily on respiratory vaccines, but also offers guidance based on emerging evidence that other vaccines, such as the herpes zoster (shingles) vaccine, may offer cardiovascular protection benefits.

Specific guidance on vaccines includes:

- Influenza : Annual influenza vaccination is recommended for all adults to reduce cardiovascular morbidity and mortality, as well as all-cause mortality. Nasal administration of the vaccine is not recommended for patients over 50 years of age.

- Pneumococcal : Adults 19 years and older with heart disease are recommended to receive this single-dose vaccine to protect against pneumonia, bacteremia, and meningitis, as well as the risk of hospitalization and death. Following the CDC/Advisory Committee on Immunization Practices recommendation, the guidance recommends a single dose of PCV20 or PCV21, or PCV15 followed by PPSV23, depending on vaccination history.

- COVID-19 : For the 2024-25 season, it was recommended that all adults with heart disease receive the seasonal COVID-19 vaccine. Future vaccination frequency may change, but it is likely to remain beneficial for those with these conditions. Benefits include a lower risk of infection, severe infection, death, myocardial infarction, COVID-19-induced pericarditis/myocarditis, COVID-19-induced stroke and atrial fibrillation, and persistent COVID-19 symptoms.

- RSV : Recommended for adults 75 years and older and for adults 50 to 74 years of age with heart disease to protect against lower respiratory tract illnesses that can lead to hospitalization and death. Current guidelines recommend a single dose, rather than annual vaccination.

- Shingles : Adults over 50 are recommended to receive two doses to protect against an increased risk of stroke and heart attack if infected. People with heart disease are at higher risk of contracting shingles.

The document outlines strategies to improve vaccination rates, address hesitancy, and overcome access barriers, noting that conversations between physicians and patients about vaccination during cardiology visits can be an important opportunity to integrate vaccination into a cardiovascular care plan.