Can Elderly Heart Failure Patients Safely Receive COVID-19 Vaccines?

Heart failure

Hello Dr.
Wu, my 82-year-old grandmother had a stroke this February.
The doctor recommended a cardiac stent placement, but she experienced acute heart failure the day after the procedure and was hospitalized for several days.
Currently, she is classified as a Stage III heart failure patient and spends most of her time sitting and watching TV or being inactive.
Due to the pandemic, we cannot encourage her to go out for walks after meals because she is taking "Jian An Xin" medication, which causes her blood pressure to be low.
Her blood pressure is normal before 8:30 AM, but it tends to drop after around 10 AM, leading to hypotension.

The medications she is currently taking are as follows:
1.
Amlodipine 2.5 mg, twice daily
2.
Jian An Xin 100 mg, twice daily
3.
Kankun 1.25 mg, once daily
4.
Lipitor 40 mg, once daily
5.
Shipa Tong 25 mg, once daily
6.
Baoshuan Tong 75 mg, once daily
I would like to ask Dr.
Wu if an elderly person who has experienced acute heart failure and has low blood pressure can receive the AZ vaccine or any other brand of vaccine? We have been hesitant and have not yet administered the vaccine.

Xiao Dai, 20~29 year old female. Ask Date: 2021/07/01

Dr. Wu Xueming reply Cardiology

Due to your grandmother's advanced age and history of heart failure, it is recommended to have her evaluated by a cardiologist in an outpatient setting.
If her current condition is unstable, it is advisable to postpone the vaccination.

Reply Date: 2021/07/01

More Info

When considering whether elderly patients with heart failure can safely receive COVID-19 vaccines, several factors must be taken into account. Your grandmother's medical history, including her recent stroke, stent placement, and subsequent acute heart failure, indicates that she is in a vulnerable health state. The medications she is currently taking, such as antihypertensives and anticoagulants, also suggest that her cardiovascular system is being closely managed.

The Centers for Disease Control and Prevention (CDC) and other health organizations have generally recommended COVID-19 vaccination for individuals with underlying health conditions, including heart disease. The benefits of vaccination, particularly in the context of the COVID-19 pandemic, often outweigh the risks associated with potential vaccine side effects. This is especially true for elderly patients who are at a higher risk for severe illness from COVID-19.

In your grandmother's case, the specific concerns regarding her ability to receive the vaccine include her history of acute heart failure and low blood pressure. While these conditions do pose risks, they do not automatically preclude vaccination. It is crucial to have a thorough evaluation by her healthcare provider, ideally a cardiologist, who can assess her current health status and determine if she is stable enough to receive the vaccine. If her heart failure is well-managed and her blood pressure is stable, vaccination may be advisable.

Regarding the choice of vaccine, both the AstraZeneca (AZ) vaccine and mRNA vaccines (like Pfizer-BioNTech and Moderna) have been shown to be effective in preventing COVID-19 and its complications. However, the AZ vaccine has been associated with rare cases of thrombosis with thrombocytopenia syndrome (TTS), which may be a concern given your grandmother's history of heart issues. On the other hand, mRNA vaccines have not shown a similar association with blood clotting issues and may be a safer option for patients with cardiovascular concerns.

It is also important to consider the timing of vaccination in relation to her medications. Generally, there is no need to stop anticoagulants or other medications before receiving the vaccine, but this should be confirmed with her healthcare provider. They can provide personalized advice based on her specific medications and health status.

In summary, elderly patients with heart failure can receive COVID-19 vaccines, but it is essential to consult with a healthcare provider to evaluate their individual risks and benefits. If your grandmother's condition is stable, vaccination is likely to be beneficial in protecting her from COVID-19. The choice of vaccine should also be discussed with her healthcare provider, considering her medical history and current medications. Ultimately, the goal is to ensure her safety while providing her with the protection that vaccination offers against COVID-19.

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