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Patients with HIV and coronary disease: are we meeting national guidelines?
Sam Emmanuel1, James Nadel1, Damien Fagan2
1St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
Insights
Management of cardiovascular disease (CVD) in HIV-infected patients in Australia shows good adherence to anti-platelet and statin therapy guidelines. However, guideline targets for cholesterol, hypertension, BMI, and depression screening are frequently unmet.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) incidence is higher in individuals with HIV infection.
- Optimal management of CVD in this population is crucial for improving patient outcomes.
- National guidelines exist for managing CVD risk factors.
Purpose of the Study:
- To assess the adherence to national management guidelines for HIV-infected patients with established CVD.
- To identify areas of strength and weakness in current clinical practices.
Main Methods:
- An audit of patient data collected by Australian general practitioners.
- Inclusion of 77 HIV-infected patients with a median age of 59.
- Evaluation of management practices against national guidelines for CVD, hypertension, BMI, and depression screening.
Main Results:
- High adherence to anti-platelet (84%) and statin therapy (97%) was observed.
- Significant shortfalls in meeting cholesterol targets, with only 31% achieving low-density lipoprotein goals.
- Limited adherence to guidelines for hypertension management (66%), body mass index targets (40%), and depression screening (32%).
Conclusions:
- While anti-platelet and statin use is generally guideline-adherent, management of HIV patients with CVD falls short of national targets, particularly for cholesterol.
- Current screening and management practices require improvement to align with established guidelines.
- Further research and clinical interventions are needed to optimize CVD care in the HIV-positive population.
Abstract:
Cardiovascular disease (CVD) has a higher incidence in patients with HIV infection. This study sought to determine whether HIV-infected patients with established CVD were being managed according to national guidelines. Data were collected from Australian general practitioners for 77 HIV-infected patients with a median age of 59 (range 54-64). There was good adherence to guidelines with regards to anti-platelet (84%; n=65; 95% confidence interval (CI) 74-92%) and statin therapy (97%; n=75; 95% CI 91-100%), despite a failure to meet cholesterol targets, with only 31% (n=24; 95% CI 21-42%) of the cohort meeting low-density lipoprotein target values. Similarly, there was limited adherence to guidelines regarding the prescriptions of medications for those with established hypertension (66%; n=51; 95% CI 55-77%), body mass index targets met (40%; n=31; 95% CI 29-52%), and depression screening (32%; n=25; 95% CI 22-44%). This Australian audit provides insight into adherence to guidelines for individuals with CVD and HIV, suggesting that current screening and management practices for these patients falls short of guidelines, particularly in relation to cholesterol management.
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