Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.
J Am Heart Assoc. 2017 Nov 14;6(11):e007107. doi: 10.1161/JAHA.117.007107.
Cardiovascular disease is emerging as a major cause of morbidity and mortality among patients with HIV. We compared use of national guideline-recommended cardiovascular care during office visits among HIV-infected versus HIV-uninfected adults.
We analyzed data from a nationally representative sample of HIV-infected and HIV-uninfected patients aged 40 to 79 years in the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey, 2006 to 2013. The outcome was provision of guideline-recommended cardiovascular care. Logistic regressions with propensity score weighting adjusted for clinical and demographic factors. We identified 1631 visits by HIV-infected patients and 226 862 visits by HIV-uninfected patients with cardiovascular risk factors, representing ≈2.2 million and 602 million visits per year in the United States, respectively. The proportion of visits by HIV-infected versus HIV-uninfected adults with aspirin/antiplatelet therapy when patients met guideline-recommended criteria for primary prevention or had cardiovascular disease was 5.1% versus 13.8% (=0.03); the proportion of visits with statin therapy when patients had diabetes mellitus, cardiovascular disease, or dyslipidemia was 23.6% versus 35.8% (<0.01). There were no differences in antihypertensive medication therapy (53.4% versus 58.6%), diet/exercise counseling (14.9% versus 16.9%), or smoking cessation advice/pharmacotherapy (18.8% versus 22.4%) between HIV-infected versus HIV-uninfected patients, respectively.
Physicians generally underused guideline-recommended cardiovascular care and were less likely to prescribe aspirin and statins to HIV-infected patients at increased risk-findings that may partially explain higher rates of adverse cardiovascular events among patients with HIV. US policymakers and professional societies should focus on improving the quality of cardiovascular care that HIV-infected patients receive.
心血管疾病正成为 HIV 感染者发病率和死亡率的主要原因。我们比较了 HIV 感染者和 HIV 未感染者在就诊时接受国家指南推荐的心血管护理的情况。
我们分析了 2006 年至 2013 年全国代表性的 40 至 79 岁年龄组 HIV 感染者和 HIV 未感染者的国家门诊医疗调查/国家医院门诊医疗调查数据。结局是提供指南推荐的心血管护理。采用具有倾向评分加权的 logistic 回归调整了临床和人口统计学因素。我们发现了 1631 次 HIV 感染者就诊和 226862 次 HIV 未感染者就诊，这些就诊者有心血管危险因素，分别代表美国每年约 220 万和 6020 万次就诊。符合主要预防指南推荐标准或患有心血管疾病的患者中，接受阿司匹林/抗血小板治疗的 HIV 感染者就诊比例为 5.1%，而 HIV 未感染者就诊比例为 13.8%（=0.03）；患有糖尿病、心血管疾病或血脂异常的患者接受他汀类药物治疗的就诊比例为 23.6%，而 HIV 未感染者就诊比例为 35.8%（<0.01）。接受抗高血压药物治疗的比例（53.4%对 58.6%）、饮食/运动咨询（14.9%对 16.9%）或戒烟咨询/药物治疗（18.8%对 22.4%）在 HIV 感染者和 HIV 未感染者之间无差异。
医生普遍较少使用指南推荐的心血管护理，并且不太可能为处于高风险的 HIV 感染者开阿司匹林和他汀类药物，这些发现可能部分解释了 HIV 感染者不良心血管事件发生率较高的原因。美国政策制定者和专业协会应重点关注提高 HIV 感染者接受心血管护理的质量。
