The new guidelines are designed to help educate people with heart disease on which vaccines to get, how often to get them, and why they’re important, says Paul Heidenreich, MD, a cardiologist and professor of medicine at Stanford Medicine in California. Dr. Heidenreich served as the writing committee chair for the new recommendations.
Vaccination Is Especially Important for People With Heart Disease
People with heart disease are also much more susceptible to severe complications from respiratory infections than people without heart disease, says Christopher Kelly, MD, a cardiologist at UNC Health in Chapel Hill, North Carolina.
Heidenreich says this is partly because the heart and lungs are connected and depend on each other. “If the lungs are damaged from infection, the person’s breathing is worse if they also have heart disease,” he explains.
Inflammation from an infection can also worsen heart disease, Dr. Kelly says.
“During the COVID pandemic, people with preexisting heart conditions were more likely to become critically ill or die as a result of infection,” says Kelly, who wasn’t involved in drafting the guidelines.
Vaccine Recommendations and Evidence
The ACC committee was made up of five professors of medicine from around the United States. Two committee members are consultants for drug companies, and three had no ties to the pharmaceutical industry.
- People with heart disease face a higher risk of negative outcomes, including hospitalization and death after a respiratory virus infection than the average person without heart disease. Heart disease also increases the likelihood of infection after exposure.
- Randomized clinical trials found that vaccines reduced infection severity.
- Observational studies are consistent with randomized trials that show lower hospitalization and death rates for people who get vaccinated.
- Negative health effects from vaccination are exceedingly rare, and the risk is far outweighed by the benefits.
What Vaccines Do I Need if I Have Heart Disease?
The committee recommends the following vaccines for people with heart disease:
- Influenza
- Pneumococcal
- COVID-19
- RSV
- Shingles
Influenza (Flu) Vaccine
Recommendation Annual flu shot for all adults. High-dose or enhanced versions for adults age 65 and older. Nasal spray vaccines are not recommended for anyone older than 50.
Pneumococcal (Pneumonia) Vaccine
Recommendation One dose of PCV20 or PCV21 for adults ages 19 and up with heart disease. All adults 50 years and older are also advised to receive the vaccine. PCV15 is an option but must be followed by PPSV23.
COVID-19 Vaccine
Recommendation Last year (2024–2025 season), the CDC recommended a seasonal COVID vaccine for everyone with heart disease. Advice on vaccine frequency may change in the future, but it’s likely that the vaccine will continue to be recommended for people with heart disease.
- Risk of infection and hospitalization
- Death from COVID-19
- Heart attack, stroke, atrial fibrillation, and myocarditis or pericarditis caused by the virus
- Long COVID symptoms
Respiratory Syncytial Virus (RSV) Vaccine
Recommendation One-time RSV vaccination for all adults 75 and older, and for adults ages 50–74 with chronic conditions like heart disease. Right now, the RSV vaccine is not recommended as an annual vaccine — guidance on that is pending.
Shingles (Zoster) Vaccine
Recommendation Two shingles vaccine doses for all adults 50 and older, spaced two to six months apart.
Have Questions? Heart Disease Experts Have Answers
The guidelines also included answers to the most common questions about vaccines.
Are vaccine side effects serious? No. Most reactions are mild, such as a sore arm and fatigue. Severe side effects are extremely rare, and the benefits for people with heart disease far outweigh the risks.
What about myocarditis from COVID-19 vaccines? Although rare, mRNA COVID-19 vaccines have been linked to a small risk of myocarditis (heart inflammation), most often in younger men. This side effect occurs in about 1 to 19 cases per million doses and is usually mild, with nearly all people making a full recovery. It’s important to note that vaccine-related myocarditis poses less of a health risk and is more benign than COVID-19 infection-related myocarditis.
Can I get multiple vaccines at once? Yes, and it may be more efficient. The only exception is that PCV15 and PPSV23 (two types of pneumonia shots) should not be given together. You may also choose to space out various vaccines to avoid experiencing several side effects at once, says Heidenreich.
Will insurance cover vaccines? Under the Affordable Care Act, CDC-recommended vaccines must be covered at no cost.
Still not convinced? Talk with your doctor. “As a cardiologist, I strongly recommend that my patients receive all age-appropriate vaccinations. People who are reluctant to undergo vaccination should discuss their concerns with their physician and seek information from primary sources, such as clinical research trials,” says Kelly.
Despite what you may hear, all vaccines are subjected to randomized, double-blind clinical trials that identify their risks and benefits — and you can usually find and review the studies if you want to read them yourself, he says.
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