In this issue of JAMA Internal Medicine, Woodruff et al¹ present a cross-sectional study of patients 50 years and older who were hospitalized and tested positive for respiratory syncytial virus (RSV), reporting that 22% experienced an acute cardiac event, including acute exacerbation of heart failure or myocardial injury. The already high in-hospital mortality rate of 5% for older adults with RSV-associated hospitalizations was doubled among those experiencing a concurrent acute cardiac event.

This report confirms for RSV a similar severity of cardiovascular adverse outcomes observed with other acute respiratory pathogens, such as influenza and SARS-CoV-2, that stem from infection-related metabolic and myocardial stress at the very least, but may also implicate other, more direct pathogen-mediated effects. Older adults are particularly vulnerable due to greater prevalence of preexisting cardiopulmonary comorbidities and lower functional reserve. In the RSV infection surge last year, the Centers for Disease Control and Prevention reported up to 10 000 deaths in adults older than 60 years, with highest risk of severe RSV infections among patients living in long-term care facilities, as well as those with preexisting lung, heart, or kidney disease or immunosuppression.²