HIV-infected individuals are at increased risk of cardiovascular death. Most of this risk can be attributed to ischemic heart disease. Differences in the management of HIV-infected patients following hospitalization for acute coronary syndromes (ACS) may contribute to worsened outcomes in this population. We hypothesized that HIV-infected individuals have higher rates of mortality following discharge, and receive sub-optimal medical management compared with uninfected individuals.
This was a retrospective cohort study using data from Symphony Health, a nationwide data warehouse. All adults admitted between January 1st, 2014 and December 31st, 2016 with ACS were included, and their characteristics and outcomes were defined by ICD-9 and 10 diagnostic codes.
A total of 1,125,126 patients were included, of whom 6,612 (0.59%) had HIV. The HIV-infected group was younger (57 vs 67 years old, p<0.0001), and had a higher burden of comorbidities such as diabetes, renal disease and substance use (p<0.0001). The type of ACS did not differ significantly between groups. The HIV-infected group had higher adjusted 30-day all-cause readmissions (14.3% vs 9.4%, OR 1.23, 95% CI 1.14-1.33, p<0.0001) and 1-year mortality (5.6% vs 5.1%, OR 1.34, 95% CI 1.2-1.5, p<0.0001). In the 12 month post-discharge period, the HIV+ group filled core cardiac medications such as statins (66.8% vs 73.7%, p<0.0001), beta blockers (67.9% vs 73.9%, p<0.0001), nitrates (31.8% vs 35.9%, p<0.0001) and antiplatelet agents (46.8% vs 51.8%, p<0.0001) at lower rates.
Following treatment for ACS, HIV-infected individuals are less likely to be taking guideline-recommended medical therapy and have worsened clinical outcomes compared to uninfected individuals. Optimizing use of medical therapy and longitudinal care of this high risk group is greatly needed.