Author + information
- Received November 15, 2019
- Revision received December 29, 2019
- Accepted December 30, 2019
- Published online May 25, 2020.
- Sebhat Erqou, MD, PhDa,b,∗ (, )
- Lan Jiang, MSa,
- Gaurav Choudhary, MDa,b,
- Michelle Lally, MDa,b,
- Gerald S. Bloomfield, MD, MPHc,
- Andrew R. Zullo, PhDa,d,
- Theresa I. Shireman, PhDd,
- Mathew Freiberg, MDe,
- Amy C. Justice, MD, PhDf,g,
- James Rudolph, MDa,b,d,
- Nina Lin, MDh and
- Wen-Chih Wu, MD, MPHa,b
- aProvidence VA Medical Center, Providence, Rhode Island
- bDepartment of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- cDuke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, North Carolina
- dCenter for Gerontology & Health Care Research and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
- eDepartment of Medicine, Vanderbilt University, Nashville, Tennessee
- fDepartment of Medicine, Yale University, New Haven, Connecticut
- gVA Connecticut Healthcare System, West Haven, Connecticut
- hDepartment of Medicine, Boston University, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Sebhat Erqou, Division of Cardiology, Providence VA Medical Center, 830 Chalkstone Street, Providence, Rhode Island 02118.
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.
The statements and opinions expressed are those of the authors and do not represent the official policy or procedures of the United States Government or the Department of Veterans Affairs. Dr. Erqou is supported by funding from Rhode Island Foundation and Center for AIDS Research at Brown University. Drs. Erqou, Choudhary, Lally, Zullo, Rudolph, and Wu are employees of the Veterans Health Administration. Drs. Rudolph and Wu are funded by the VA Health Services Research and Development Center of Innovation in Long Term Services and Supports (CIN 13-4193). Dr. Bloomfield is supported by R01MD013493. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received November 15, 2019.
- Revision received December 29, 2019.
- Accepted December 30, 2019.
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.