TY - JOUR
T1 - The Risk for Sudden Cardiac Death Among Patients Living With Heart Failure and Human Immunodeficiency Virus
AU - Alvi, Raza M.
AU - Neilan, Anne M.
AU - Tariq, Noor
AU - Hassan, Malek O.
AU - Awadalla, M.
AU - Zhang, Lili
AU - Afshar, Maryam
AU - Rokicki, Adam
AU - Mulligan, Connor P.
AU - Triant, Virginia A.
AU - Zanni, Markella V.
AU - Neilan, Tomas G.
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/9
Y1 - 2019/9
N2 - Objectives: The aim of this study was to determine the incidence of sudden cardiac death (SCD) among persons living with human immunodeficiency virus infection (PHIV) with heart failure (HF), who were hospitalized for HF, and the risk factors associated with it. Background: HF is associated with an increased risk for SCD. PHIV are at heightened risk for HF. Methods: This was a retrospective study of 2,578 patients hospitalized with HF from a single academic center, of whom 344 were PHIV. The outcome of interest was SCD. Subgroup analyses were performed by strata of viral load (VL) and left ventricular ejection fraction (LVEF) <35%, 35% to 49%, and ≥50%. Results: Of 2,578 patients with HF, 2,149 (86%) did not have implantable cardioverter-defibrillators; of these, there were 344 PHIV and 1,805 uninfected control subjects. Among PHIV with HF, 313 (91%) were prescribed antiretroviral therapy and 64% were virally suppressed. There were 191 SCDs over a median follow-up period of 19 months. Compared with control subjects, PHIV had a 3-fold increase in SCD (21.0% vs. 6.4%; adjusted odds ratio: 3.0; 95% confidence interval: 1.78 to 4.24). Among PHIV, cocaine use, lower LVEF, absence of beta-blocker prescription, and VL were predictors of SCD. The SCD rate among PHIV with undetectable VL was similar to the rate among uninfected subjects. Similar findings were observed by LVEF strata. Among PHIV with HF without conventional indications for an implantable cardioverter-defibrillator, the rate of SCD was 10% per year. Conclusions: PHIV hospitalized with HF are at a markedly increased risk for SCD. SCD risk was increased in patients with lower LVEFs, lower CD4 counts, and higher VL.
AB - Objectives: The aim of this study was to determine the incidence of sudden cardiac death (SCD) among persons living with human immunodeficiency virus infection (PHIV) with heart failure (HF), who were hospitalized for HF, and the risk factors associated with it. Background: HF is associated with an increased risk for SCD. PHIV are at heightened risk for HF. Methods: This was a retrospective study of 2,578 patients hospitalized with HF from a single academic center, of whom 344 were PHIV. The outcome of interest was SCD. Subgroup analyses were performed by strata of viral load (VL) and left ventricular ejection fraction (LVEF) <35%, 35% to 49%, and ≥50%. Results: Of 2,578 patients with HF, 2,149 (86%) did not have implantable cardioverter-defibrillators; of these, there were 344 PHIV and 1,805 uninfected control subjects. Among PHIV with HF, 313 (91%) were prescribed antiretroviral therapy and 64% were virally suppressed. There were 191 SCDs over a median follow-up period of 19 months. Compared with control subjects, PHIV had a 3-fold increase in SCD (21.0% vs. 6.4%; adjusted odds ratio: 3.0; 95% confidence interval: 1.78 to 4.24). Among PHIV, cocaine use, lower LVEF, absence of beta-blocker prescription, and VL were predictors of SCD. The SCD rate among PHIV with undetectable VL was similar to the rate among uninfected subjects. Similar findings were observed by LVEF strata. Among PHIV with HF without conventional indications for an implantable cardioverter-defibrillator, the rate of SCD was 10% per year. Conclusions: PHIV hospitalized with HF are at a markedly increased risk for SCD. SCD risk was increased in patients with lower LVEFs, lower CD4 counts, and higher VL.
KW - heart failure
KW - human immunodeficiency virus
KW - sudden cardiac death
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U2 - 10.1016/j.jchf.2019.04.025
DO - 10.1016/j.jchf.2019.04.025
M3 - Article
C2 - 31401096
AN - SCOPUS:85070852928
SN - 2213-1779
VL - 7
SP - 759
EP - 767
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 9
ER -