American College of Cardiology: How to Address Barrier to Immunization for Adults with CVD

The American College of Cardiology (ACC) on August 27 issued a new Concise Clinical Guidance (CCG) on vaccination in adults with cardiovascular disease (CVD), underscoring the importance of respiratory vaccines—including influenza, COVID-19, and respiratory syncytial virus (RSV)—as part of standard prevention and treatment strategies.

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While the evidence strongly supports vaccination, CCG authors emphasize that translating these recommendations into clinical practice requires addressing implementation challenges and, importantly overcoming patient barriers to vaccination uptake. The writers note that while the benefits are documented and clear, vaccination rates among adults, particularly those with cardiovascular disease, remain suboptimal. The reasons reflect a complex interplay of patient hesitancy, access limitations, and healthcare system barriers.

A dedicated section of the CCG highlights evidence-based strategies for cardiovascular care teams to improve vaccination rates, to confidently address patient concerns and vaccine hesitancy, and improve access to vaccination services within cardiology practice settings. Following is a summary of the recommendations.

Strategies to Improve Vaccination Rates

• Community and School-Based Interventions: These approaches, along with financial incentives, show limited effectiveness in improving adult vaccination rates compared to targeted behavioral approaches.
• Behavioral Messaging: Studies of Medicare beneficiaries show that mailed letters—especially repeat letters—modestly improve vaccination uptake regardless of behavioral content, and text messages stating a “vaccine is reserved for you” deliver the greatest impact on improving vaccine rates.
• Cardiovascular-Focused Messaging: The NUDGE-FLU trial in Denmark demonstrated that electronic communications emphasizing cardiovascular benefits and repeat letters reliably increase influenza vaccination rates across age groups and populations with chronic diseases, as well as among individuals with both recent and stable CVD.

Addressing Vaccine Hesitancy

• Definition: Vaccine hesitancy is “a state of indecision and uncertainty that precedes a decision to become (or not become) vaccinated.” It differs from vaccine resistance, which is characterized by outright opposition rather than uncertainty.
• Influencing Factors: Hesitancy is exacerbated by socioeconomic challenges, misinformation, social and familial networks, and prior negative experiences with vaccines.
• Education and Communication: Education from trusted healthcare providers—especially primary care physicians—proves most effective in overcoming hesitancy. Comprehensive education should address misconceptions (such as the belief that vaccines cause the disease), explain benefits, and discuss common side effects. Group-based interventions may be aided by community leaders, media, and social platforms to combat misinformation.
• Frequently Asked Questions Tool: The guidance includes a FAQ table specifically addressing concerns about side effects, risk of myocarditis, vaccine costs, safety, and the concurrent administration of multiple vaccines, assisting clinicians in patient discussions.

Improving Access to Vaccination

• System Barriers: Although CDC-recommended vaccines are covered by insurance, actual access depends on whether clinicians routinely recommend and administer vaccines and whether vaccine workflows are integrated into clinical practice. Only about 30% of primary care physicians assess adult vaccination status at clinics, illustrating missed opportunities for intervention; similar gaps likely exist in specialty practices.
• Opportunities in Cardiology Clinics: Cardiology clinics serve as pivotal access points for vaccine assessment and intervention, especially since patients may have greater comfort discussing immunization in the context of cardiovascular secondary prevention, including post-MI and follow-up visits. Clinicians should actively consider vaccination “in the suite of secondary therapies for patients with recent MI or CVD”.
• Practical Recommendations: Cardiologists must familiarize themselves with vaccine availability in their health systems and proactively direct patients to alternative options, such as local pharmacies, when administration at the point of care is not feasible. Health system resources and insurance status have a profound impact on uptake, as seen during rapid COVID-19 vaccine rollout in well-resourced systems.
• Equity and Access: Special focus is required for under/uninsured populations and those with poor healthcare access to ensure broad and equitable vaccine uptake. Targeted communication, clinician and staff education, and systematic “vaccine champion” roles help drive success in implementation across different care environments.

For a summary of Frequently Asked [Patient] Questions prepared by the ACC, please click here

For a review of 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on Adult Immunizations as Part of Cardiovascular Care, please click here.