Oseltamivir After Influenza:Associated With Reduced Incidence of Recurrent Adverse Cardiovascular Outcomes

Use of Oseltamivir After Influenza Infection Is Associated With Reduced Incidence of Recurrent Adverse Cardiovascular Outcomes Among Military Health System Beneficiaries With Prior Cardiovascular Diseases

S. Ward Casscells, MD; Elder Granger, MD, FACP, FACPE; Amii M. Kress, MPH; Andrea Linton, MS;Mohammad Madjid, MD, MSc and Linda Cottrell, BS

From Health Affairs (S.W.C.), TRICARE Management Activity (E.G.), and Health Program Analysis and Evaluation (A.M.K., A.L., L.C.), West Falls Church, Va; and Texas Heart Institute and Baylor College of Medicine (M.M.), Houston, Tex.

Correspondence to Andrea Linton, MS, TRICARE Management Activity/Health Program Analysis and Evaluation, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041-3206. E-mail andrea.linton@wowway.com

Background: Influenza infection has been associated with increased risk of adverse cardiac and cerebral vascular outcomes. Oseltamivir, a treatment for influenza, has been shown to decrease the severity of an influenza episode, but few data exist regarding its potentiallyprotective effect against recurrent vascular outcomes among influenza patients with a history of vascular disease.

Methods and Results: Electronic healthcare service and pharmacy records for 37 482 TRICARE beneficiaries, aged 18 and older, with a coded history of cardiovascular (CV) disease and a subsequent diagnosis of influenza from October 1, 2003, through September 30, 2007, were examined. Subjects were grouped according to whether they had filled a prescription for oseltamivir within 2 days of their influenza diagnosis. The incidence of recurrent CV events within 30 days after the influenza diagnosis among oseltavmivir-treated and untreated subjects was 8.5% and 21.2%, respectively (P<0.005). Subject age was a persistent and significant contributor to the likelihood of recurrent CV outcomes. After controlling for the differences in demographics among treated and untreated cohorts using a propensity-scored logistic regression model, a statistically significant protective effect was associated with oseltamivir treatment (odds ratio, 0.417; 95% CI, 0.349 to 0.498).

Conclusions: Our findings suggests that oseltamivir treatment for influenza is associated with significant decrease in the risk of recurrent CV events in subjects with a history of CV disease. These findings merit confirmation in further prospective and controlled studies. Meanwhile, in patients with CV disease, strict adherence withcurrent practice guidelines for prevention and treatment of influenza is recommended.