Abstract

Respiratory syncytial virus (RSV), traditionally regarded as a major cause of bronchiolitis and pneumonia in childhood, is increasingly recognized as an important cause of morbidity, hospitalization, and mortality among older adults and individuals with chronic diseases. Adults with heart failure, coronary artery disease, and other cardiovascular diseases are at particularly high risk of severe RSV infection. The relationship between RSV and cardiovascular disease is bidirectional: pre-existing cardiovascular disease increases the risk of severe RSV infection, whereas acute RSV infection may trigger heart failure decompensation, acute coronary syndrome, myocardial injury, atrial and ventricular arrhythmias, and other acute cardiac events. Recent large observational studies and systematic reviews have shown that approximately one-fifth of older adults hospitalized with RSV experience an acute cardiac event. Acute heart failure is the most frequently reported cardiac complication, particularly among patients with pre-existing heart failure. Although acute coronary events are less common, they remain clinically important, especially in individuals with underlying coronary artery disease. Systemic inflammation, hypoxemia, sympathetic activation, myocardial oxygen supply-demand imbalance, endothelial dysfunction, procoagulant activity, and cardiopulmonary hemodynamic interactions are considered the principal mechanisms contributing to these complications. The introduction of RSV vaccines targeting the prefusion F protein has opened a new era in the prevention of RSV infection in adults. Randomized controlled trials and real-world data demonstrate substantial reductions in RSV-associated lower respiratory tract disease and hospitalization among older adults. Preventive strategies may be particularly important for individuals with cardiovascular disease because of their increased risk of severe RSV. However, further prospective studies are needed to determine whether vaccination reduces specific cardiovascular outcomes, including myocardial infarction, acute heart failure, arrhythmia, stroke, and cardiovascular mortality.