Sebhat Erqou1, Lan Jiang2, Gaurav Choudhary3, Michelle Lally3, Gerald S Bloomfield4, Andrew R Zullo5, Theresa I Shireman6, Mathew Freiberg7, Amy C Justice8, James Rudolph9, Nina Lin10, Wen-Chih Wu3. 1. Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: sebhaterqou@gmail.com. 2. Providence VA Medical Center, Providence, Rhode Island. 3. Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island. 4. Duke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, North Carolina. 5. Providence VA Medical Center, Providence, Rhode Island; Center for Gerontology & Health Care Research and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island. 6. Center for Gerontology & Health Care Research and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island. 7. Department of Medicine, Vanderbilt University, Nashville, Tennessee. 8. Department of Medicine, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut. 9. Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; Center for Gerontology & Health Care Research and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island. 10. Department of Medicine, Boston University, Boston, Massachusetts.
Abstract
OBJECTIVES: This study sought to investigate outcomes of heart failure (HF) in veterans living with human immunodeficiency virus (HIV). BACKGROUND: Data on outcomes of HF among people living with human immunodeficiency virus (PLHIV) are limited. METHODS: We performed a retrospective cohort study of Veterans Health Affairs data to investigate outcomes of HF in PLHIV. We identified 5,747 HIV+ veterans with diagnosis of HF from 2000 to 2018 and 33,497 HIV- frequency-matched controls were included. Clinical outcomes included all-cause mortality, HF hospital admission, and all-cause hospital admission. RESULTS: Compared with HIV- veterans with HF, HIV+ veterans with HF were more likely to be black (56% vs. 14%), be smokers (52% vs. 29%), use alcohol (32% vs. 13%) or drugs (37% vs. 8%), and have a higher comorbidity burden (Elixhauser comorbidity index 5.1 vs. 2.6). The mean ejection fraction (EF) (45 ± 16%) was comparable between HIV+ and HIV- veterans. HIV+ veterans with HF had a higher age-, sex-, and race-adjusted 1-year all-cause mortality (30.7% vs. 20.3%), HF hospital admission (21.2% vs. 18.0%), and all-cause admission (50.2% vs. 38.5%) rates. Among veterans with HIV and HF, those with low CD4 count (<200 cells/ml) and high HIV viral load (>75 copies/μl) had worse outcomes. The associations remained statistically significant after adjusting for extensive list of covariates. The incidence of all-cause mortality and HF admissions was higher among HIV+ veterans with ejection fraction <45% CONCLUSIONS: HIV+ veterans with HF had higher risk of hospitalization and mortality compared with their HIV- counterparts, with worse outcomes reported for individuals with lower CD4 count, higher viral load, and lower ejection fraction. Published by Elsevier Inc.
OBJECTIVES: This study sought to investigate outcomes of heart failure (HF) in veterans living with human immunodeficiency virus (HIV). BACKGROUND: Data on outcomes of HF among people living with human immunodeficiency virus (PLHIV) are limited. METHODS: We performed a retrospective cohort study of Veterans Health Affairs data to investigate outcomes of HF in PLHIV. We identified 5,747 HIV+ veterans with diagnosis of HF from 2000 to 2018 and 33,497 HIV- frequency-matched controls were included. Clinical outcomes included all-cause mortality, HF hospital admission, and all-cause hospital admission. RESULTS: Compared with HIV- veterans with HF, HIV+ veterans with HF were more likely to be black (56% vs. 14%), be smokers (52% vs. 29%), use alcohol (32% vs. 13%) or drugs (37% vs. 8%), and have a higher comorbidity burden (Elixhauser comorbidity index 5.1 vs. 2.6). The mean ejection fraction (EF) (45 ± 16%) was comparable between HIV+ and HIV- veterans. HIV+ veterans with HF had a higher age-, sex-, and race-adjusted 1-year all-cause mortality (30.7% vs. 20.3%), HF hospital admission (21.2% vs. 18.0%), and all-cause admission (50.2% vs. 38.5%) rates. Among veterans with HIV and HF, those with low CD4 count (<200 cells/ml) and high HIV viral load (>75 copies/μl) had worse outcomes. The associations remained statistically significant after adjusting for extensive list of covariates. The incidence of all-cause mortality and HF admissions was higher among HIV+ veterans with ejection fraction <45% CONCLUSIONS: HIV+ veterans with HF had higher risk of hospitalization and mortality compared with their HIV- counterparts, with worse outcomes reported for individuals with lower CD4 count, higher viral load, and lower ejection fraction. Published by Elsevier Inc.
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