Hospital Pulido Valente

INTRODUCTION:Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection, with substantial morbidity and mortality in older adults, yet its impact in this population remains underrecognized compared with childhood RSV. Despite the availability of effective vaccines, RSV immunization in adults is underutilized, as observed for other vaccines. AREAS COVERED:We summarize the RSV burden in adult populations and present clinical and real-world evidence supporting efficacy/effectiveness and safety of three approved RSV vaccines. We explore barriers to adult vaccine uptake - including limited awareness, lack of reimbursement, mistrust, misinformation, and inconsistent guidance - and highlight broader benefits of adult immunization, including reducing antimicrobial resistance and promoting healthy aging. We conclude that to improve uptake, communication strategies should include messages that emphasize how vaccination prevents severe illness, preserves independence, and supports everyday well-being. We highlight that a life-course immunization strategy, built on trust, is essential to achieve equitable protection across populations. EXPERT OPINION:Adult vaccines remain undervalued despite their proven safety and benefits, which extend beyond infection prevention to support healthy aging and reduce antimicrobial resistance. To maximize their impact, strategies such as harmonizing recommendations, improving reimbursement, leveraging digital tools, and addressing vaccine hesitancy through better communication and research are essential.

AIMS:To assess the relationship between coffee consumption and all-cause mortality in heart failure (HF) patients, using data from the National Health and Nutrition Examination Survey (NHANES). METHODS AND RESULTS:We analyzed data from NHANES (2003-2018), including 915 participants with HF who reported daily caffeine intake. Participants were categorized into coffee consumption levels: zero, one, two, three, and ≥4 cups/day. Multivariate logistic regression evaluated the relationship between coffee intake and mortality, adjusted for age, sex, and income. The mean participant age was 67, with 401 (44%) women. While one to three cups/day showed no significant association with mortality, consuming ≥4 cups/day increased mortality risk (OR: 1.58; 95% CI: 1.16-2.16; p=0.004). Age was the strongest predictor of mortality, while income and sex showed marginal associations. CONCLUSIONS:Consuming up to three cups of coffee per day may be safe for patients with HF, while intake of four or more cups warrants caution due to the association with increased mortality. These findings underscore the need for further research to provide reliable recommendations.

Abstract Background Polypharmacy is highly prevalent in patients with heart failure with reduced ejection fraction (HFrEF), driven by multimorbidity, older age, and the need for multiple guideline-directed medical therapies (GDMT). Excessive medication burden may increase the risk of adverse events, reduce adherence, and worsen clinical outcomes. This study aimed to evaluate the prognostic effect of polypharmacy in patients with HFrEF. Methods Prospective, single-centre study that included consecutive de novo HFrEF patients followed in a HF-specialised outpatient clinic from 2019 to 2024. Medication burden was categorised as <5 drugs (no polypharmacy), 5–9 drugs (polypharmacy), and ≥10 drugs (hyper-polypharmacy). The primary endpoint was a composite of HF hospitalisation and all-cause mortality. Survival analyses were performed using Kaplan–Meier curves, and multivariable Cox regression assessed the independent prognostic effect of medication burden. Statistical significance was defined as p<0.05. Results A total of 262 patients were included (mean age 65.6 ± 15.4 years; 70.6% male), with a mean follow-up of 3.1 years. Medication burden was high (mean 8.4 ± 2.4 drugs), with 171 patients (65.3%) classified as having polypharmacy and 77 (29.4%) hyper-polypharmacy. Compared with the polypharmacy group, patients with hyper-polypharmacy were older (70.8 vs 63.3 years, p<0.001), had lower creatinine clearance (60.1 vs 74.1 mL/min, p<0.001), higher NT-proBNP concentrations (3337 vs 2414 pg/mL, p=0.012), and higher frailty scores (CFS 3.6 vs 3.1, p<0.001). The composite endpoint occurred in 17.5% of patients with polypharmacy and 32.5% with hyper-polypharmacy. Kaplan–Meier analysis showed progressively lower event-free survival with increasing medication burden. In multivariable Cox regression, hyper-polypharmacy independently predicted the composite endpoint (HR 2.1; 95% CI 1.21–5.37; p=0.003), after adjustment for age, renal function, NT-proBNP and frailty. Conclusion Polypharmacy and hyper-polypharmacy were common and associated with significantly worse event-free survival in patients with HFrEF. Although HF severity and GDMT use were similar between groups, patients with higher medication burden were older, frailer, had poorer renal function and higher NT-proBNP. Hyper-polypharmacy independently predicted heart failure hospitalisation and mortality, underscoring the need for structured medication review and strategies to reduce treatment burden in HFrEF patients.For image description, please refer to the figure legend and surrounding text.

BACKGROUND:Respiratory syncytial virus (RSV) is an important cause of acute respiratory infection (ARI), but its burden in Portuguese adults remains under-investigated. METHODS:This single-centre retrospective database cohort study examined RSV-ARI hospitalisations in adults aged ≥18 years over six consecutive seasons (2018/19 to 2023/24), a period which includes years impacted by COVID-19 disruptions. Outcomes included the prevalence of RT-PCR-confirmed RSV-ARI among tested ARI admissions, clinical features and adverse outcomes, healthcare resource use and direct costs; outcomes were also described for influenza-ARI to provide context. Analyses were descriptive without any comparison between the groups. RESULTS:Of 7,125 ARI-hospitalisations 3,011 underwent RSV/influenza testing. The overall prevalence of RT-PCR-confirmed RSV-ARI and influenza-ARI in tested admissions was 8.1% and 20.3%, respectively. The study included 244 RSV-ARI and 612 influenza-ARI admissions, most ≥60 years old; 77.1% of RSV-ARI admissions and 61.4% of influenza-ARI admissions involved high-risk patients with comorbidities. Complications within 90 days were frequent, including acute cardiac events (RSV-ARI, 47.1%; influenza-ARI, 38.2%), respiratory failure (46.3% and 31.5%), pneumonia (34.0% and 22.4%) and acute renal disease (34.0% and 29.3%). All-cause in-hospital mortality was 19.7% for RSV-ARI (influenza-ARI, 12.8%). Mean length of stay for RSV-ARI was 8.5 days (interquartile range ([IQR], 9.7) with a mean cost of €4 757; for influenza-ARI, 7.4 days (IQR 8.9) and €3 537, respectively. CONCLUSIONS:RSV represents an important cause of ARI-hospitalisation in older adults, especially in those with comorbidities, with a substantial clinical and economic burden, which was similar or higher than influenza (GSK study identifier: VEO-000773).