Background
People with HIV (PWH) have a higher incidence of cardiovascular disease, including heart failure (HF) and acute myocardial infarction (AMI) than people without HIV (PWoH). In the general population, 30-day readmissions following hospitalizations for HF and AMI are common, and reducing these readmissions is a national quality of care priority. This study compares the 30-day readmission risk between adult PWH and PWoH hospitalized for HF or AMI in the US.
Methods
We conducted a retrospective cohort analysis using the 2021 Nationwide Readmissions Database. Using International Classification of Diseases, Tenth Revision, Clinical Modification codes, we identified adults admitted for HF or AMI. The primary outcome was 30-day all-cause unplanned readmission. We estimated age-adjusted risk ratios (aRR) of readmission by HIV status using random-effects logistic regressions with marginal estimates. Subgroup analyses were conducted stratified by age and sex. All analyses used survey weights to generate national estimates.
Results
We included 1,055,524 (weighted) adult index (initial) hospitalizations for HF and 475,514 for AMI. In both HF and AMI populations, PWH were more likely than PWoH to be male (HF: 69% vs. 53%; AMI: 80% vs. 64%) and to reside in low-income areas (HF: 53% vs. 32%; AMI: 45% vs. 29%). Among HF index hospitalizations, PWH had a significantly higher readmission risk (32%) compared to PWoH (22%), (aRR=1.37; 95%CI=1.30-1.44). Similarly, for AMI hospitalizations, PWH had a significantly higher readmission risk (18%) than PWoH (12%), (aRR=1.67; 95%CI=1.47-1.88). For HF, the most common diagnostic categories for both PWH and PWoH readmissions were cardiovascular (57% vs. 55%), infectious (15% vs. 14%), and respiratory (7% vs. 6%). For AMI, the leading reasons for readmission among PWoH were cardiovascular (57%), infectious (13%), and digestive (7%), while in PWH, the top categories were cardiovascular (42%), infectious (15%), and both digestive and respiratory (6%). In age- and sex-stratified analysis, PWH consistently had higher readmission risks than PWoH for both HF and AMI, with the largest disparities observed in younger males and older females (Figure).
Conclusions
For hospitalizations due to HF and AMI, PWH had significantly higher 30-day readmission risks than PWoH. Targeted interventions are needed to reduce readmission risks among PWH with HF and AMI, especially as the burden of these comorbid conditions grows.