HIV-Associated Heart Failure: Phenotypes and Clinical Outcomes in a Safety-Net Setting.

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Human immunodeficiency virus (HIV) is linked to increased heart failure (HF) risk.
• Understanding HF phenotypes and outcomes in people with HIV (PWH) within safety-net systems is crucial due to their significant healthcare utilization.

Approach:

• Utilized an electronic health record cohort of individuals with HF in a municipal safety-net system (2001-2019).
• Compared HF phenotypes, mortality, HF hospitalizations, and causes of death between individuals with and without HIV.
• Linked data to the National Death Index Plus for comprehensive outcome assessment.

Key Points:

• PWH were diagnosed with HF a decade earlier on average and had a higher proportion with reduced ejection fraction.
• HIV was associated with a 55% increased risk of all-cause mortality and lower odds of HF hospitalization.
• Causes of death in PWH with HF were less frequently cardiovascular and more often attributed to substance use and HIV-related conditions.

Conclusions:

• In safety-net settings, HIV infection is associated with elevated mortality among HF patients.
• Despite lower HF hospitalization rates, PWH experience higher overall mortality due to non-cardiovascular causes.
• Findings underscore the need for integrated care addressing both HIV and cardiovascular health in vulnerable populations.