ACC Issues Vaccination Guidelines for Adults with Cardiovascular Disease

The American College of Cardiology (ACC) has released new vaccination recommendations for adults with cardiovascular disease, advising immunization against COVID-19, influenza, RSV, pneumonia, and shingles. Published in JACC, the guidelines provide evidence-based support for each vaccine and include FAQs to guide discussions between patients and clinicians as part of routine prevention and treatment.

The guidance also provides detailed evidence for each vaccine recommendation and answers to frequently asked questions to guide conversations between clinicians and patients.

“Vaccination against communicable respiratory diseases and other serious diseases is critical for people with heart disease, but barriers exist to ensuring people are educated on which vaccines to get, how often to get them and why they are important,” said Paul Heidenreich, MD, FACC, chair of the CCG writing committee. “With this document, we want to encourage clinicians to have these conversations and help their patients manage vaccination as part of a standard prevention and treatment plan.”

People with heart disease have a higher risk of infection when exposed to a respiratory virus and a higher risk of adverse outcomes, including hospitalization and death. Studies have shown that vaccines are highly effective in reducing these risks; however, a recent study showed only 30% of primary care physicians are assessing their patients’ vaccination status at clinic visits.

The ACC issued this CCG to consolidate vaccine-specific recommendations made by ACC/American Heart Association guidelines and the Centers for Disease Control and Prevention. The guidance mainly focuses on respiratory vaccines but also offers guidance based on emerging evidence that other vaccines-such as the herpes zoster (shingles) vaccine-may offer cardiovascular protective benefits.

Vaccine specific guidance includes:

• Influenza – An annual flu vaccine is recommended for all adults to reduce cardiovascular morbidity, cardiovascular mortality and all-cause death. Nasal versions of the vaccine are not recommended in patients over 50.

• Pneumococcal – recommended for adults 19 or older with heart disease to get this one-time vaccine to protect against pneumonia, bacteremia and meningitis and related risk of hospitalization and death. Following CDC/Advisory Committee on Immunization Practices recommendation, the guidance advises a single dose of PCV20 or PCV21, or PCV15 followed by PPSV23 depending on prior vaccination history.

• COVID-19 – For the 2024–25 season, all adults with heart disease were recommended to receive the seasonal COVID-19 vaccine. Future vaccination frequency may change, but it is likely vaccination will remain beneficial for those with heart disease. Benefits include reduced risk of infection, severe infection, death, heart attack, COVID-19 induced pericarditis/myocarditis, COVID-19 induced stroke and atrial fibrillation, and long COVID symptoms.

• RSV – recommended for adults 75 or older and for adults aged 50–74 with heart disease to protect against lower respiratory disease that can result in hospitalization and death. Current guidance recommends a single dose, rather than annual vaccination.

• Shingles – recommended for adults 50 or older to receive two doses to protect against increased risk of stroke and heart attack when infected. People with heart disease are at an increased risk of shingles infection.

The document outlines strategies to improve vaccination rates, address hesitancy and overcome barriers to access, noting that clinician-patient discussions about vaccination during cardiology visits can be an important opportunity to integrate vaccination into a cardiovascular care plan.

Reference:

A. Heidenreich, P, Bhatt, A, Nazir, N. et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on Adult Immunizations as Part of Cardiovascular Care: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Published online Aug. 26, 2025. doi:10.1016/j.jacc.2025.07.003.