Should My 81-Year-Old Grandfather with Heart Issues Get the AZ Vaccine?

Should I get the AZ vaccine? A dilemma?

My grandfather is 81 years old and has been suffering from diabetes for nearly forty years.
For the past ten years, he has been taking medication for cardiovascular diseases.
In March of this year, due to severe blockage and calcification of the coronary arteries, he had two stents placed.
Currently, he is taking the following medications: 1.
Apixaban 2.5 mg twice daily, 2.
Amlodipine 100 mg twice daily, 3.
Carvedilol 1.25 mg twice daily, 4.
Lipitor (Atorvastatin) 40 mg once daily, 5.
Isosorbide Mononitrate 25 mg once daily, 6.
Clopidogrel 75 mg once daily, 7.
Metformin 25 mg once daily, 8.
Insulin NovoMix 30, 16 units in the morning and evening.
I would like to ask the doctor whether a heart failure patient like him should receive the AZ vaccine.
Our family has been very worried these past few days and doesn't know what to do.
Thank you very much to Dr.
He for his response yesterday.
My grandfather's heart function has been compromised due to prolonged coronary artery blockage.
In 2020, all three major coronary arteries were blocked.
The first hospital lacked the necessary skills to address the serious arteries and only placed two stents, neglecting the severe ones for a year.
My grandfather subsequently experienced falls due to insufficient blood flow, and three months later, he had a stroke.
After transferring to another hospital, the doctor placed two stents in the severely blocked arteries (which required grinding due to severe calcification) and mentioned that the previously placed stents were unnecessary (the needed procedures were not performed, resulting in unnecessary expenses).
Even after placing two more stents, his heart failure condition has not improved.
He usually eats and then rests for 2 to 3 hours before lying down again.
His eating speed is very slow, and he seems to have difficulty swallowing (though a throat examination showed no issues; it is likely due to heart weakness).
He used to walk around the campus five laps in the afternoon, with each lap taking about ten minutes, resting briefly before continuing.
However, due to the pandemic, he hasn't gone out for a month.
Today, he tested and found that after walking for about five minutes, he becomes short of breath and needs to rest before continuing.
His blood pressure is low due to taking Amlodipine, but he feels no discomfort.
Due to the summer heat, his systolic pressure is around 78-79, diastolic pressure is 48-49, and his heart rate is around 60.
This is his current condition.
Should he go for the AZ vaccine next week or wait a little longer?

Bu zhi suo cuo, 30~39 year old female. Ask Date: 2021/06/19

Dr. He Dongjin reply Cardiology

Hello, any medical intervention carries risks.
If your grandfather is frail and has not been going out, and you have had minimal contact with the outside world, you might consider delaying the vaccination.
Otherwise, the benefits generally outweigh the risks.
Each individual's body reacts differently to medications.
If there are concerns about the AstraZeneca vaccine, you might wait for other brands.
My own father is 90 years old, has had a stent placed, is on dialysis, and has already received the AstraZeneca vaccine.
He is currently doing well, and I wish the same for your grandfather.
I will keep your grandfather in my prayers.
Changhua Hospital is here to support you.

Reply Date: 2021/06/19

More Info

When considering whether your 81-year-old grandfather with significant cardiovascular issues should receive the AstraZeneca (AZ) COVID-19 vaccine, several factors must be taken into account. Given his medical history, including long-standing diabetes and recent heart complications, it is essential to weigh the risks and benefits of vaccination carefully.

Firstly, it is important to recognize that older adults, particularly those with underlying health conditions such as diabetes and cardiovascular disease, are at a higher risk for severe outcomes from COVID-19. The risk of complications from COVID-19, including hospitalization and death, significantly outweighs the potential risks associated with the AZ vaccine. Studies have shown that the benefits of vaccination in preventing severe illness and death from COVID-19 far exceed the risks of vaccine-related side effects, including the rare occurrence of thrombosis with thrombocytopenia syndrome (TTS), which has been associated with the AZ vaccine.

Your grandfather's current medications and health status indicate that he has been managing multiple chronic conditions, including heart disease and diabetes. The medications he is taking, such as anticoagulants and antihypertensives, suggest that he is under close medical supervision. While there is a concern regarding the potential for blood clotting issues with the AZ vaccine, the overall incidence of such events is very low, and the benefits of vaccination in preventing COVID-19 complications are substantial.

It is also noteworthy that the AZ vaccine has been shown to be effective in older populations, providing robust protection against severe disease. The vaccine's efficacy in older adults is comparable to that of mRNA vaccines, such as Pfizer-BioNTech and Moderna, which are also recommended for individuals with underlying health conditions.

Regarding the timing of vaccination in relation to his current medications, there is generally no requirement to stop anticoagulant or other medications before receiving the vaccine. However, it is always prudent to consult with his healthcare provider to ensure that there are no specific contraindications based on his unique medical history. The healthcare provider may recommend monitoring his condition closely around the time of vaccination to manage any potential side effects effectively.

In conclusion, based on the information provided, it is advisable for your grandfather to receive the AZ vaccine. The risks associated with COVID-19 in individuals with his health profile far exceed the potential risks of vaccination. However, it is crucial to have a thorough discussion with his healthcare provider to ensure that he is in a stable condition for vaccination and to address any specific concerns related to his medications and overall health status. Vaccination can significantly enhance his protection against COVID-19, which is particularly important given the ongoing pandemic and the risks associated with his underlying health conditions.

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