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

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• HIV infection is a known risk factor for heart failure (HF).
• Data on HF phenotypes and outcomes in people with HIV (PWH) within safety-net systems are limited.
• Safety-net systems care for a significant portion of PWH in the US.

Purpose of the Study:

• To compare HF phenotypes, mortality, and causes of death in PWH versus those without HIV.
• To investigate HF outcomes within a large municipal safety-net system.
• To understand the specific challenges faced by PWH with HF in under-resourced healthcare settings.

Main Methods:

• Retrospective analysis of an electronic health record cohort (2001-2019) of individuals with HF.
• Linked EHR data with the National Death Index Plus for mortality outcomes.
• Compared HF phenotypes, all-cause mortality, HF hospitalization, and causes of death between PWH and HIV-uninfected individuals.

Main Results:

• PWH were diagnosed with HF 10 years younger on average and had a higher proportion with reduced ejection fraction.
• HIV was associated with a 55% increased risk of all-cause mortality (HR 1.55) and lower odds of HF hospitalization (OR 0.51).
• Causes of death in PWH with HF were less often cardiovascular and more frequently attributed to substance use.

Conclusions:

• In safety-net systems, HIV infection is linked to significantly higher mortality among HF patients.
• Despite lower HF hospitalization rates, PWH with HF experience worse survival.
• Non-cardiovascular causes, including substance use and HIV-related conditions, contribute to excess mortality in this population.