ACC guidance puts vaccination at the heart of cardiovascular care

Clinical takeaway: Review vaccination status during cardiovascular visits and ensure eligible patients with cardiovascular disease (CVD) receive recommended influenza, pneumococcal, COVID-19, RSV, and zoster vaccines.

The American College of Cardiology (ACC) is urging cardiovascular clinicians to treat adult vaccination as part of routine cardiovascular care, citing evidence that respiratory infections can trigger myocardial infarction (MI), heart failure (HF) decompensation, and other cardiovascular events. The 2026 guidance updates recommendations published in 2025 with newly available trial data.

Influenza vaccination remains a priority. Adults aged 65 years or older should preferentially receive a high-dose vaccine, with recombinant or adjuvanted formulations as alternatives; adults aged 18 to 64 years should receive a standard-dose vaccine. New randomized evidence strengthens the case for high-dose vaccination: compared with standard-dose vaccine, it reduced hospitalizations for respiratory disease, CVD, and HF among older adults. Among patients with HF in one trial, the number needed to vaccinate with high-dose rather than standard-dose vaccine to prevent one hospitalization was 105.

Pneumococcal vaccination is recommended for all adults aged 50 years or older who have not previously received a pneumococcal conjugate vaccine and for adults aged 19 to 49 years with chronic risk conditions, including chronic heart disease, HF, or cardiomyopathy. Hypertension alone is not considered a qualifying risk condition.

The ACC also recommends RSV vaccination for all adults aged 50 years or older with CVD who have not previously received it; RSV vaccination is not currently recommended annually. Zoster vaccination remains recommended as a 2-dose series for all adults aged 50 years or older, with emerging evidence suggesting possible cardiovascular benefits in addition to preventing shingles.

What's changed

• New randomized data strengthen support for high-dose influenza vaccine in adults aged 65 years or older. Compared with standard-dose vaccination, high-dose vaccination reduced respiratory, cardiovascular, and HF hospitalizations, with greater absolute benefit among patients with CVD.

• Updated evidence confirms the effectiveness of 2025-2026 influenza, COVID-19, and RSV vaccines.

• New RSV evidence includes a large randomized trial showing vaccination reduced cardiorespiratory disease and was associated with lower rates of stroke and CVD. The optimal interval for repeat RSV vaccination remains uncertain.

The guidance also calls on cardiology practices to identify vaccination gaps, administer vaccines when feasible, and routinely refer patients to pharmacies or other vaccination sites when they cannot vaccinate onsite.

“Vaccination should be considered in the suite of secondary therapies for patients with recent MI or CVD,” the authors wrote.

Source: Heidenreich PA, et al. (2026 Aug 05) J Am Coll Cardiol. Adult immunizations as part of cardiovascular care: 2026 ACC concise clinical guidance