Should My 81-Year-Old Father Get the AZ Vaccine? A Heart Health Dilemma

Receiving the AZ vaccine feels like a difficult choice, almost like a death sentence vaccine?

My father, who is 81 years old, has been suffering from diabetes for nearly forty years.
For the past ten years, he has been taking cardiovascular medications (Berkley) due to shortness of breath while walking.
Two years ago, he started taking another medication (Kankin).
In March of this year, he underwent the placement of two stents due to severe calcification and blockage of the coronary arteries.
However, it is suspected that the stent implantation process may have injured a blood vessel, leading to acute heart failure.
Fortunately, he has since recovered enough to eat and walk, but he experiences shortness of breath after walking for ten minutes and needs to sit down to rest before he can walk again.
His blood pressure is low, which may be a side effect of the medications and the summer heat.
His systolic blood pressure is in the seventies, diastolic pressure is 48, and his heart rate is around 60 beats per minute.
He currently does not have any discomfort.
The medications he is taking include: 1.
Amlodipine 2.5 mg twice daily, 2.
Cardiac Care 100 mg twice daily, 3.
Kankin 1.25 mg once daily, 4.
Lipitor 40 mg once daily, 5.
Mucolytic 25 mg once daily, 6.
Antithrombotic 75 mg once daily, 7.
Glucose Control 25 mg once daily, and 8.
Insulin (NovoMix) 30, 16 units in the morning and evening.
I would like to ask the doctor: 1.
Should he receive the AZ vaccine? 2.
Should he wait a bit longer? 3.
Or should he consider getting a different brand of vaccine?

Xiao Xia Mi, 30~39 year old female. Ask Date: 2021/06/20

Dr. Li Han reply Cardiology

Hello, regarding your concerns about COVID-19 vaccination, it is honestly difficult to provide a definitive answer.
Based on your father's medication, 1.
The concurrent use of antiplatelet agents (such as Clopidogrel) and anticoagulants (such as Apixaban) suggests that, in addition to coronary artery disease, he may also have atrial fibrillation; 2.
The heart failure medication (such as Carvedilol) is specifically for patients with heart failure with reduced ejection fraction, indicating that your father has significant myocardial damage or dysfunction associated with his coronary artery disease.
Without the aforementioned medications, the estimated two-year mortality rate would likely exceed 50%.
However, your father's age and potential comorbidities place him in a high-risk group during this COVID-19 pandemic, and if he were to unfortunately contract the virus, the mortality rate could exceed 30%.
It can only be said that your father's condition does not present an absolute contraindication to the COVID-19 vaccine (including AstraZeneca), but his blood pressure and heart rhythm may cause hesitation for the evaluating physician.
Ultimately, the decision rests with your father and your family.
Wishing you all the best from Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2021/06/20

More Info

When considering whether your 81-year-old father should receive the AstraZeneca (AZ) COVID-19 vaccine, especially given his complex medical history, it is essential to weigh the risks and benefits carefully. Your father's medical background includes significant factors such as diabetes, heart disease, and recent heart surgery involving stent placement, which complicates the decision-making process.

Firstly, it is important to recognize that older adults, particularly those with underlying health conditions, are at a higher risk for severe outcomes from COVID-19. The risk of complications from COVID-19, including hospitalization and death, generally outweighs the potential risks associated with vaccination. Studies have shown that the AZ vaccine is effective in preventing severe illness and hospitalization due to COVID-19, even in older populations. Furthermore, the incidence of vaccine-related complications, such as thrombosis, is relatively low compared to the risks posed by COVID-19 itself.

Given your father's recent history of acute heart failure and the medications he is currently taking, it is crucial to consult with his healthcare provider before proceeding with vaccination. His doctor can assess his overall health status, including his heart function, blood pressure, and any potential interactions with his current medications. For instance, the low blood pressure readings you mentioned (systolic in the 70s and diastolic at 48) could indicate that he is at risk for hypotension, which may need to be managed before vaccination.

In terms of timing, if your father's health is stable and he is not experiencing any acute symptoms, vaccination could be considered. However, if he is currently experiencing significant shortness of breath or other concerning symptoms, it may be prudent to delay vaccination until his condition stabilizes. The healthcare provider may also recommend monitoring his heart function and overall health before proceeding with the vaccine.

Regarding alternative vaccines, if there are concerns about the AZ vaccine due to his medical history, other options such as mRNA vaccines (Pfizer-BioNTech or Moderna) may be considered. These vaccines have shown strong efficacy and safety profiles in older adults and those with underlying health conditions. However, the final decision should be made in consultation with his healthcare provider, who can provide personalized recommendations based on his specific health needs.

In summary, while the AZ vaccine can be administered to older adults with underlying health conditions, including heart disease, careful consideration and consultation with a healthcare provider are essential. The benefits of vaccination, particularly in the context of the ongoing COVID-19 pandemic, generally outweigh the risks, but individual health factors must guide the decision-making process. It is crucial to ensure that your father is in a stable condition and that any potential risks are managed appropriately before proceeding with vaccination.

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