Year: 2024
Type: article
Study design: Observational Study
Abstract: Background Human immunodeficiency virus (HIV) is associated with increased risk of heart failure (HF) but data regarding phenotypes of heart failure and outcomes after HF diagnosis, especially within the safety-net which is where half of people with HIV in the United States receive care, are less clear. Methods Using an electronic health record cohort of all individuals with HF within a municipal safety-net system from 2001-2019 linked to the National Death Index Plus, we compared HF phenotypes, all-cause mortality, HF hospitalization, and cause of death for individuals with and without HIV. Results Among people with HF (n=14,829), 697 individuals had HIV (4.7%). Persons with HIV (PWH) were diagnosed with HF ten years younger on average. A higher proportion of PWH had a reduced ejection fraction at diagnosis (37.9% vs 32.7%). Adjusted for age, sex, and risk factors, coronary artery disease on angiography was similar by HIV status. HIV was associated with 55% higher risk of all-cause mortality (HR 1.55; 95% CI 1.37-1.76; P<0.001) and lower odds of HF hospitalization (OR 0.51; 95% CI 0.39-0.66; P<0.001). Among PWH with HF, cause of death was less often attributed to cardiovascular disease (22.5% vs 54.6% uninfected; P<0.001) and more to substance use (17.9% vs 9.3%; P<0.001), consistent with autopsy findings in a subset (n=81). Conclusions Among people with HF who receive care within a municipal safety-net system, HIV infection is associated with higher mortality, despite lower odds of HF hospitalization, attributable to non-cardiovascular causes including substance-related and HIV-related mortality. Clinical Perspectives People with HIV develop heart failure 10 years earlier than people without HIV, with a higher proportion with HFrEF at diagnosis. HIV is associated with higher mortality among people with heart failure, primarily due to non-cardiovascular causes including HIV/AIDS and substance use. Research Perspectives The reasons for higher mortality in PWH with HF are not yet fully understood; higher levels of myocardial fibrosis may predispose people with substance use and advanced HIV disease to increased risk of mortality.
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,700
Awards: Cardiac Pathology and Risk Prediction for Sudden Cardiac Death in Patients with HIV, Role of Hematopoietic System and Proteomics in HIV-Associated CardiovascularDisease, UCSF Career Development Program in Cardiopulmonary, Hematologic, and Immunologic Comorbidities of HIV (CHIC), G5270435057, Comprehensive autopsy characterization of sudden cardiac death, Low Cardiorespiratory Fitness and Chronotropic Incompetence in HIV: Risk Factors, Cardiovascular Implications, and Exercise Training as Treatment, Clonal Hematopoeisis of Indeterminate Potential and Risk of Autopsy-defined Sudden Cardiac Death, Clinical and Translational Science Institute
OpenAlex ID: W4404611921