Conference Coverage

Respiratory Syncytial Virus Infection Linked to Higher Risk of Acute Systolic Heart Failure Compared with Influenza

Anthony Calabro, MA

Key Highlights

  • Respiratory syncytial virus infection was associated with a 3.8–4.0-fold higher heart failure risk than influenza.
  • Elevated risk persisted for 6 months after infection.
  • The study findings highlight RSV’s systemic cardiac impact and need for post-infection monitoring.

Researchers presenting a large, multi-institutional analysis examining the risk of acute systolic heart failure following respiratory syncytial virus (RSV) versus influenza infection at the American Heart Association Scientific Sessions 2025 in New Orleans, LA, found that RSV poses a significantly higher cardiac risk extending months beyond initial infection.

Using the TriNetX Global Collaborative Network, the study investigators analyzed adult patients diagnosed with RSV or influenza between January 1, 2015, and December 31, 2024, across 143 healthcare organizations. Patients with preexisting heart failure, ischemic heart disease, amyloidosis, or rheumatic mitral valve disease were excluded. Propensity score matching (1:1) controlled for age, sex, race, diabetes, obesity, and chronic pulmonary disease. Incidence of acute systolic heart failure was evaluated at 30-day and 180-day intervals using risk ratios, odds ratios, Kaplan-Meier survival curves, and hazard ratios.

Study Findings

At 30 days, heart failure occurred in 0.1% of patients with RSV compared with 0.038% of patients with influenza (risk ratio 3.84; hazard ratio 3.86; P < .001). At 180 days, the RSV group continued to demonstrate elevated risk (0.2% vs 0.049%; risk ratio 3.98; hazard ratio 4.07; P < .001). Kaplan-Meier analysis showed lower heart failure-free survival among RSV patients, with consistent results across risk metrics and time frames, despite small absolute event numbers.

Clinical Implications

These findings identify RSV as a significant, underrecognized contributor to acute systolic heart failure. Given the sustained risk beyond the acute illness period, clinicians should consider closer cardiovascular monitoring following RSV infection, particularly among older or high-risk adults. Expanded RSV prevention strategies, including vaccination, may mitigate downstream cardiac events.

Expert Commentary

“These findings suggest that RSV carries a significantly elevated risk of acute systolic heart failure compared to influenza, persisting for at least six months post-infection,” the study authors concluded. “The consistent results across risk metrics and time windows underscore the systemic effects of RSV and its potential to trigger new-onset heart failure.” The team also emphasized the importance of enhanced post-viral cardiac monitoring and expanded RSV vaccination in shaping preventive care.

Conclusion

RSV infection is linked to a significantly increased risk of acute systolic heart failure compared with influenza, with elevated risk persisting up to six months post-infection. These findings underscore RSV’s cardiovascular burden and support ongoing efforts to expand prevention and post-infection cardiac assessment.

Reference
Bowen A, Asjad SJ, Saroya S, et al. Risk of acute systolic heart failure following respiratory syncytial virus compared to influenza: a multi-institutional retrospective cohort study. Presented at: American Heart Association Scientific Sessions 2025; New Orleans, LA. https://professional.heart.org/en/meetings/scientific-sessions