PURPOSE: The 2001 & 2005 ACC/AHA Guidelines for Heart Failure (SHF) recommend vaccination (VAC) for influenza (FLU) and for pneumococcal pneumonia. Nationally, rates of VAC for FLU in elderly patients was 65.5% in 2003 and was 62.7% in 2004. For high risk adults, including SHF patients, rates over the same time-periods were low at 34.2% and 25.5% respectively. In fiscal year 2002, a quality improvement project regarding VAC for both FLU and pneumonia in SHF was undertaken. We report the 3 year results regarding VAC of SHF patients in an indigent rural SHF disease management clinic.
METHODS: Baseline VAC status was included into the database in 2002 at our SHF clinic at LJ Chabert Medical Center in Houma, Louisiana, one of 8 safety-net state hospitals. All SHF visits were monitored for VAC status by clinic nurses via the process of a checklist, documenting VAC status. Patients were then offered the VAC if not already completed, where appropriate and were then administered by the nurse at the same visit, when available. The outcome measured was the annual FLU VAC status and the 5-year pneumococcal VAC status.
RESULTS: The fiscal year rates of FLU VAC was 33% (n=98) in 2002, 36% (n=183) in 2003, 54% (n=237) in 2004, and 33% (n=92) in 2005. There was a shortage of available FLU VAC in 2005. For pneumonia VAC, the cumulative rate for each fiscal year was 9% (n=42) in 2003, 48% (n=174) in 2004, and 62% (n=62) in 2005. There were no differences by year regarding demograhics. Median annual income was $11,800.
CONCLUSION: VAC rates were equivalent or lesser than known US rates at program initiaton. At 3 year follow-up, yearly FLU rates and cumulative pneumonia rates continued to improve, though FLU rates dropped in 2005 due to FLU VAC shortage that year.
CLINICAL IMPLICATIONS: A simple process improvement VAC checklist helps facilitate SHF guidleline suggested preventative measures. Further study will focus on patients attitudes, as a distinct subset refused VAC at each visit.
DISCLOSURE: Lee Arcement, None.