OBJECTIVES : Infection with respiratory viruses, such as influenza and respiratory syncytial virus (RSV), accounts for substantial morbidity and mortality among older adults each year. Much of this results from infection-related cardiorespiratory events, stemming from the high incidence of multimorbidity. Infection risk is particularly high for older adults residing in long-term care facilities (LTCFs), where outbreaks are common. Though high-risk, the cardiorespiratory events attributed to influenza and RSV has yet to be quantified among this vulnerable population.

METHODS : We conducted a retrospective cohort study identifying long-stay LTCF resident care episodes (100+ days) using national MedPAR inpatient claims and Minimum Data Set assessments during six respiratory seasons (2011-2017). Viral surveillance data was provided by the National Respiratory and Enteric Virus Surveillance System. Residents were followed until >10 days outside the LTCF, Medicare disenrollment, or death. Cardiorespiratory event hospitalizations (e.g., asthma exacerbation, heart failure) were identified using primary diagnosis codes. Influenza and RSV-attributable cardiorespiratory events were estimated using a negative binomial excess model adjusted for weekly circulating influenza and RSV. Length of stay and costs of influenza and RSV-attributable events were calculated.

RESULTS : The study population included 3,138,962 long-stay resident care episodes with 5,079,872 person-years of follow-up. Overall, there were 10,939 (95% CI: 9,413; 12,464) influenza and RSV-attributable cardiorespiratory events, with an incidence of 215 (185; 245) events per 100,000 person-years. The cost and length of stay for influenza and RSV-attributable events were $87,297,239 ($74,668,477; $99,942,001) and 56,858 days (48,757; 64,968); respectively.

CONCLUSIONS : Influenza and RSV account for many cardiorespiratory events among U.S. LTCF residents, presenting a large economic burden on the healthcare system. Infection Prevention and Control Programs should ensure that preventive measures are implemented, including adequate supply and use of personal protective equipment and vaccination of both LTCF residents and staff. Funding: Sanofi Pasteur.