Background/Objectives: Respiratory syncytial virus (RSV) causes morbidity in older adults with cardiovascular disease, in whom infection may precipitate severe lower respiratory tract disease, hospitalization, functional decline, and cardiovascular destabilization. We evaluate the evidence for RSV vaccination in cardiovascular disease and propose a jurisdiction-adaptable framework for integrating vaccination into cardiovascular care. Methods: Observational studies, randomized trials, pragmatic and test-negative studies, prespecified cardiovascular analyses of DAN-RSV, and eligibility recommendations were narratively synthesized and translated into a pathway encompassing patient identification, eligibility and risk assessment, vaccine delivery and co-administration, documentation, and follow-up. Results: Acute cardiac events are frequent during RSV hospitalization, and cardiovascular risk may persist after infection. Randomized trials establish protection against RSV-associated lower respiratory tract disease and respiratory illness, while real-world studies support effectiveness against RSV-related hospitalization. DAN-RSV reduced all-cause cardiorespiratory hospitalization but did not demonstrate significant reductions in cardiovascular hospitalization, myocardial infarction, heart failure (HF) hospitalization, atrial fibrillation, stroke, cardiovascular death, or major adverse cardiovascular events; observational associations with lower post-vaccination cardiovascular-event rates remain hypothesis-generating. The framework prioritizes adults aged ≥75 years and those aged 50–74 years with high-risk cardiovascular conditions where consistent with national recommendations, embeds vaccination assessment across cardiology, HF, primary care, pharmacy, and long-term care, and incorporates co-administration, documentation, and outcome surveillance. Conclusions: The principal contribution is a pathway for moving RSV vaccination from recommendation to routine preventive care for adults with cardiovascular disease. It anchors implementation in established RSV and cardiorespiratory benefits while treating cardiovascular-event reduction as a research priority rather than a demonstrated indication.

Background/Objectives: Streptococcus pneumoniae is a major cause of community-acquired pneumonia and invasive pneumococcal disease, particularly in older adults and people with cardiovascular disease. Pneumococcal infection may precipitate heart failure, arrhythmias, myocardial infarction, stroke, functional decline, hospitalization, and death. This review examines pneumococcal disease as a cardiovascular stressor, the effectiveness of adult pneumococcal vaccination, and the comparative clinical relevance of higher-valency conjugate vaccines. Methods: We conducted a narrative review of randomized trials, phase 3 immunogenicity and safety studies, real-world effectiveness analyses, observational cardiovascular cohorts, meta-analyses, epidemiological surveillance reports, regulatory documents, and current European, U.S., and Spanish recommendations. Results: Clinical evidence supports protection against vaccine-type invasive pneumococcal disease and pneumococcal pneumonia. Associations between pneumococcal vaccination and lower myocardial infarction risk derive predominantly from observational studies and do not establish causality; a reduction in cardiovascular events remains unproven. The 23-valent polysaccharide vaccine is an older, unconjugated platform that induces a T-cell-independent response without the immunological memory produced by conjugate vaccines; therefore, a higher nominal valency does not necessarily imply greater or more durable clinical effectiveness. PCV20 and PCV21 are higher-valency conjugate vaccines with partially overlapping non-nested serotype compositions. Both have adult regulatory indications in Spain, but their evidence bases differ: PCV20 has phase 3 immunogenicity and safety evidence plus emerging real-world effectiveness data, whereas PCV21 currently has a broad phase 3 immunogenicity and safety program. No head-to-head clinical-outcome study has established superior effectiveness of either vaccine. Differences in estimated serotype coverage reflect epidemiological overlap and do not directly quantify clinical protection. Spanish serotype epidemiology is highly dynamic, with persistent adult disease caused by serotypes included in each formulation and recent increases in selected legacy serotypes retained in PCV20. A serotype-specific association between serotypes 3 and 9N and cardiovascular events has been reported in one invasive-disease cohort but was not reproduced in a larger pneumococcal pneumonia cohort. Conclusions: Pneumococcal vaccination should be integrated into cardiovascular care for eligible adults to prevent pneumococcal disease. Any additional benefit in preventing myocardial infarction or other cardiovascular events, including long-term complications, remains uncertain. Vaccine selection should follow official recommendations and consider age, previous vaccination, regional epidemiology, serotype-associated disease burden and severity, antimicrobial resistance, and availability rather than valency or immunogenicity alone.

Background: Polypharmacy is highly prevalent in patients with heart failure (HF), but the prognostic significance of severe polypharmacy remains uncertain. This systematic review and meta-analysis evaluated its association with all-cause mortality in adults with HF. Methods: PubMed, MEDLINE, Embase, Scopus and the Cochrane Library were searched from inception through August 2026. Observational studies assessing severe polypharmacy (the highest medication-burden category in each study; ≥9 to ≥15 medications) and all-cause mortality in adults with HF were eligible. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Leave-one-out sensitivity analyses and post hoc threshold-specific analyses were performed. Risk of bias and certainty of evidence were assessed using the Newcastle–Ottawa Scale (NOS) and GRADE, respectively. The protocol was registered in PROSPERO (CRD420261507517). Results: Nine studies included 44,213 patients. Severe polypharmacy was not significantly associated with all-cause mortality (HR 1.04, 95% CI 0.86–1.26; p = 0.67; I² = 79%). NOS scores ranged from 6 to 9. Leave-one-out HRs ranged from 0.996 to 1.097, with all 95% CIs including 1. In six studies defining severe polypharmacy as ≥10 medications, the pooled HR was 1.15 (95% CI 1.00–1.32; p = 0.054; I² = 37.8%). Certainty of evidence was very low because of serious inconsistency and imprecision. Conclusions: No statistically significant association was identified, but very low certainty of evidence precludes firm conclusions, and clinically important associations cannot be excluded. Medication count should be interpreted alongside treatment appropriateness and clinical complexity.