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Zhou Y, Zhang X, Gao Y, Alvi RM, Erqou S, Chen Y, Wang H, Wang W, Li X, Zanni MV, Neilan TG, Vermund SH, Qian HZ, Qian F. Risk of death and readmission among individuals with heart failure and HIV: A systematic review and meta-analysis. J Infect Public Health 2024; 17:70-75. [PMID: 37992436 DOI: 10.1016/j.jiph.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/10/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
The association between human immunodeficiency virus (HIV) status and readmissions and death outcomes in patients with established heart failure (HF) remains unclear. We conducted a systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science up to March 1st, 2023, for cohort studies of adult patients (≥18 years) diagnosed with HF and recorded HIV status at baseline. Our analysis included 7 studies with 10,328 HF patients living with HIV and 48,757 HF patients without HIV. Compared to HF patients without HIV, those with HIV had a higher risk of all-cause deaths (HR: 1.20, 95% CI: 1.15-1.25). HIV infection was also associated with increased risks of HF-associated readmission (HR: 1.34, 95% CI: 1.03-1.75) and all-cause readmission (HR: 1.27, 95% CI: 1.10-1.46). Our study highlights the independent association between HIV and poor HF outcomes, emphasizing the need for improved management in individuals living with HIV.
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Affiliation(s)
- Yaqin Zhou
- Xiangya Nursing School, Central South University, Changsha, China.
| | | | - Yanxiao Gao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Raza M Alvi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sebhat Erqou
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Yuqing Chen
- Xiangya Nursing School, Central South University, Changsha, China.
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, China.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Xianhong Li
- Xiangya Nursing School, Central South University, Changsha, China; School of International Education, Hainan Medical College, Haikou, China.
| | - Markella V Zanni
- Metabolism Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Tomas G Neilan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sten H Vermund
- School of Public Health, Yale University, New Haven, CT, USA.
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT, USA.
| | - Frank Qian
- Section of Cardiovascular Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Human Immunodeficiency Virus Infection-Associated Cardiomyopathy and Heart Failure. J Pers Med 2022; 12:jpm12111760. [PMID: 36573732 PMCID: PMC9695202 DOI: 10.3390/jpm12111760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 12/30/2022] Open
Abstract
The landscape of human immunodeficiency virus (HIV) epidemiology and treatment is ever-changing, with the widespread and evolving use of antiretroviral therapy (ART). With timely ART, people living with HIV (PLWH) are nearing the life expectancies and the functionality of the general population; nevertheless, the effects of HIV and ART on cardiovascular health remain under investigation. The pathophysiology of HIV-related cardiomyopathy and heart failure (HF) have historically been attributed to systemic inflammation and changes in cardiometabolic function and cardiovascular architecture. Importantly, newer evidence suggests that ART also plays a role in modulating the process of HIV-related cardiomyopathy and HF. In the short term, newer highly active ART (HAART) seems to have cardioprotective effects; however, emerging data on the long-term cardiovascular outcomes of certain HAART medications, i.e., protease inhibitors, raise concerns about the potential adverse effects of these drugs in the clinical course of HIV-related HF. As such, the traditional phenotypes of dilated cardiomyopathy and left ventricular systolic failure that are associated with HIV-related heart disease are incrementally being replaced with increasing rates of diastolic dysfunction and ischemic heart disease. Moreover, recent studies have found important links between HIV-related HF and other clinical and biochemical entities, including depression, which further complicate cardiac care for PLWH. Considering these trends in the era of ART, the traditional paradigms of HIV-related cardiomyopathy and HF are being called into question, as is the therapeutic role of interventions such as ventricular assist devices and heart transplantation. In all, the mechanisms of HIV-related myocardial damage and the optimal approaches to the prevention and the treatment of cardiomyopathy and HF in PLWH remain under investigation.
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Wu KC, Woldu B, Post WS, Hays AG. Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV. Curr Opin HIV AIDS 2022; 17:261-269. [PMID: 35938459 PMCID: PMC9365326 DOI: 10.1097/coh.0000000000000753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To summarize the state-of-the-art literature on the epidemiology, disease progression, and mediators of heart failure, tachyarrhythmias, and sudden cardiac death in people living with HIV (PLWH) to inform prevention strategies. RECENT FINDINGS Recent studies corroborate the role of HIV as a risk enhancer for heart failure and arrhythmias, which persists despite adjustment for cardiovascular risk factors and unhealthy behaviors. Immune activation and inflammation contribute to the risk. Heart failure occurs more frequently at younger ages, and among women and ethnic minorities living with HIV, highlighting disparities. Prospective outcome studies remain sparse in PLWH limiting prevention approaches. However, subclinical cardiac and electrophysiologic remodeling and dysfunction detected by noninvasive testing are powerful disease surrogates that inform our mechanistic understanding of HIV-associated cardiovascular disease and offer opportunities for early diagnosis. SUMMARY Aggressive control of HIV viremia and cardiac risk factors and abstinence from unhealthy behaviors remain treatment pillars to prevent heart failure and arrhythmic complications. The excess risk among PLWH warrants heightened vigilance for heart failure and arrhythmic symptomatology and earlier testing as subclinical abnormalities are common. Future research needs include identifying novel therapeutic targets to prevent heart failure and arrhythmias and testing of interventions in diverse groups of PLWH.
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Affiliation(s)
- Katherine C. Wu
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
| | - Bethel Woldu
- MedStar Heart and Vascular Institute, Baltimore, MD
- MedStar Georgetown University, Department of Medicine, Division of Cardiology, Washington DC
| | - Wendy S. Post
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
| | - Allison G. Hays
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
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Patil S, Rajendraprasad S, Velagapudi M, Aurit S, Andukuri V, Alla V. Readmissions among People Living with HIV Admitted for Hypertensive Emergency. South Med J 2022; 115:429-434. [PMID: 35777749 DOI: 10.14423/smj.0000000000001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES People with human immunodeficiency virus (HIV) are at an increased risk of developing cardiovascular diseases. Hypertensive emergency (HTNE), a complication of hypertension with potentially serious health implications, has high healthcare utilization. We attempted to determine the association between HIV status and risk for 30-day readmission after index hospitalization for HTNE. METHODS We used the Nationwide Readmissions Database to identify all of the admissions during 2010-2017 with a primary discharge diagnosis of HTNE. Admissions were stratified by HIV status and comparisons were made with the χ2 test. We investigated predictors of all-cause 30-day readmission via multivariable logistic regression. RESULTS A total of 612,854 hospitalizations with a primary discharge diagnosis of HTNE were identified, and 4115 (0.7%) were HIV positive. There was a total of 43,937 (7.16%) 30-day readmissions, and the rate was higher in regard to positive HIV status (29.8% vs 15.0%; P < 0.001). Renal failure was the most frequent reason for HIV readmissions and the second most frequent reason for non-HIV readmissions (15.6% vs 10.3%; P < 0.001). In contrast, heart failure was the most frequent reason for non-HIV readmissions and the second most frequent reason for HIV readmissions (10.3% vs 11.9%; P = 0.234). There was a higher median cost for HIV readmissions in comparison to non-HIV readmissions ($7660 vs $7490; P < 0.001). Finally, HIV was attributed to 40.6% increased odds of readmission after adjusting for pertinent clinical and demographic factors (P < 0.001). CONCLUSIONS HIV-positive status is associated with an increased risk for 30-day readmission after index hospitalization for HTNE.
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Affiliation(s)
- Shantanu Patil
- From the Departments of Cardiology, Infectious Diseases, Clinical Research, and Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Sanu Rajendraprasad
- From the Departments of Cardiology, Infectious Diseases, Clinical Research, and Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Manasa Velagapudi
- From the Departments of Cardiology, Infectious Diseases, Clinical Research, and Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Sarah Aurit
- From the Departments of Cardiology, Infectious Diseases, Clinical Research, and Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Venkata Andukuri
- From the Departments of Cardiology, Infectious Diseases, Clinical Research, and Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Venkata Alla
- From the Departments of Cardiology, Infectious Diseases, Clinical Research, and Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
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Peng Q, Yang Q. Risk factors and management of pulmonary infection in elderly patients with heart failure: A retrospective analysis. Medicine (Baltimore) 2021; 100:e27238. [PMID: 34559121 PMCID: PMC10545257 DOI: 10.1097/md.0000000000027238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/16/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Pulmonary infection is common in patients with heart failure, yet the risk factors remain unclear. We aimed to evaluate the clinical characteristics and risk factors of pulmonary infection in elderly patients with heart failure, to provide reference to the prevention of pulmonary infection.This study was a retrospective study design. We included elderly heart failure patient admitted to our hospital from April 1, 2018 to August 31, 2020. The characteristics and clinical data of pulmonary infection and no infection patients were assessed. Logistic regression analyses were conducted to identify the risk factors of pulmonary infections in patients with heart failure.A total of 201 patients were included. The incidence of pulmonary infection in patients with heart failure was 23.88%. There were significant differences in the age, diabetes, New York Heart Association (NYHA) grade, left ventricular ejection fraction (LVEF), C-reactive protein (CRP) between infection and no infection group (all P < .05), and there were not differences in the sex, body mass index, alcohol drinking, smoking, hypertension, hyperlipidemia, length of hospital stay between 2 groups (all P > .05). Logistic regression analyses indicated that age ≥70 years, diabetes, NYHA grade III, LVEF ≤55%, and CRP ≥10 mg/L were the independent risk factors of pulmonary infections in patients with heart failure (all P < .05). Pseudomonas aeruginosa (34.48%), Staphylococcus aureus (19.57%), and Klebsiella pneumoniae (15.22%) were the most common 3 pathogens in patients with pulmonary infection.Heart failure patients with age ≥70 years, diabetes, NYHA grade III, LVEF ≤55%, and CRP ≥10 mg/L have higher risks of pulmonary infections, preventive measures targeted on those risk factors are needed to reduce pulmonary infections.
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Affiliation(s)
- Qi Peng
- Cardiac Surgery, Wuhan Asia Heart Hospital, Jianghan District, Wuhan, Hubei, China
| | - Qin Yang
- Pharmacy Intravenous Admixture Services, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Jiangan District, Wuhan, Hubei, China
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Erqou S, Jiang L, Choudhary G, Lally M, Bloomfield GS, Zullo AR, Shireman TI, Freiberg M, Justice AC, Rudolph J, Lin N, Wu WC. Heart Failure Outcomes and Associated Factors Among Veterans With Human Immunodeficiency Virus Infection. JACC-HEART FAILURE 2020; 8:501-511. [PMID: 32278680 DOI: 10.1016/j.jchf.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 01/06/2023]
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.
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Affiliation(s)
- Sebhat Erqou
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Lan Jiang
- Providence VA Medical Center, Providence, Rhode Island
| | - Gaurav Choudhary
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michelle Lally
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, North Carolina
| | - Andrew R Zullo
- 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
| | - Theresa I Shireman
- Center for Gerontology & Health Care Research and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Mathew Freiberg
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Amy C Justice
- Department of Medicine, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - James Rudolph
- 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
| | - Nina Lin
- Department of Medicine, Boston University, Boston, Massachusetts
| | - Wen-Chih Wu
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
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