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The Risk for Sudden Cardiac Death Among Patients Living With Heart Failure and Human Immunodeficiency Virus
Raza M Alvi1, Anne M Neilan2, Noor Tariq3
1Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Bronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai, Bronx, New York.
JACC. Heart Failure
|August 12, 2019
Summary
Persons living with HIV and heart failure face a threefold increased risk of sudden cardiac death. Managing viral load and heart function is crucial for reducing this risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Heart failure (HF) significantly elevates the risk of sudden cardiac death (SCD).
- Persons living with human immunodeficiency virus (PHIV) have a higher prevalence of HF.
Purpose of the Study:
- To determine the incidence of SCD among hospitalized patients with HF who are also living with HIV.
- To identify risk factors associated with SCD in this population.
Main Methods:
- Retrospective study of 2,578 HF patients (344 PHIV).
- Subgroup analyses based on viral load (VL) and left ventricular ejection fraction (LVEF).
- Outcome of interest was SCD over a median 19-month follow-up.
Main Results:
- PHIV with HF had a 3-fold increased SCD risk compared to uninfected controls (21.0% vs. 6.4%).
- Predictors of SCD in PHIV included cocaine use, lower LVEF, no beta-blocker prescription, and higher VL.
- SCD rates were similar between PHIV with undetectable VL and uninfected subjects.
Conclusions:
- Hospitalized PHIV patients with HF face a substantially elevated risk of SCD.
- Lower LVEF, lower CD4 counts, and higher VL are associated with increased SCD risk in PHIV.
- Effective management of viral load may mitigate SCD risk in PHIV with HF.
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