Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA.
Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Eur Heart J Qual Care Clin Outcomes. 2021 May 3;7(3):273-279. doi: 10.1093/ehjqcco/qcaa088.
Persons living with HIV (PLWH) have increased cardiovascular mortality, which may in part be due to differences in the management of acute coronary syndromes (ACS). The purpose of this study was to compare the in-hospital and post-discharge management and outcomes of ACS among persons with and without HIV.
This was a retrospective cohort study using data from Symphony Health, a data warehouse. All patients admitted between 1 January 2014 and 31 December 2016 with ACS were identified by International Classification of Diseases billing codes. Multivariate logistic regression models were used to examine in-hospital, 30-day and 12-month event rates between groups. A total of 1 125 126 individuals were included, 6612 (0.59%) with HIV. Persons living with HIV were younger (57.4 ± 10.5 vs. 67.4 ± 12.9 years, P< 0.0001) and had more medical comorbidities. Acute coronary syndrome type did not differ significantly with HIV status. Persons living with HIV were less likely to undergo coronary angiography (35.2% vs. 37.2%, adjusted OR 0.87, 95% CI 0.83-0.92, P < 0.0001), and those with both HIV and STEMI underwent fewer drug-eluting stents (60.1% vs. 68.5%, adjusted OR 0.81, 95% CI 0.68-0.96, P = 0.016). Persons living with HIV had higher adjusted rates of inpatient mortality (OR 1.29, 95% CI 1.15-1.44; P < 0.0001), 30-day readmission (OR 1.18, 95% CI 1.09-1.27; P < 0.0001) and 12-month mortality (OR 1.32, 95% CI 1.22-1.44; P < 0.0001). Twelve months following discharge, PLWH filled cardiac medications at lower rates.
In a contemporary cohort of persons hospitalized for ACS, PLWH received less guideline-supported interventional and medical therapies and had worse clinical outcomes. Strategies to optimize care are warranted in this unique population.
感染艾滋病毒（HIV）的人患心血管疾病的死亡率增加，这在一定程度上可能是由于急性冠状动脉综合征（ACS）管理上的差异所致。本研究的目的是比较有和没有 HIV 的人 ACS 的住院和出院后管理和结局。
这是一项使用 Symphony Health 数据仓库中的数据进行的回顾性队列研究。通过国际疾病分类计费代码识别 2014 年 1 月 1 日至 2016 年 12 月 31 日期间因 ACS 住院的所有患者。使用多变量逻辑回归模型比较组间住院、30 天和 12 个月的事件发生率。共纳入 1125126 人，其中 6612 人（0.59%）患有 HIV。感染 HIV 的人更年轻（57.4±10.5 岁 vs. 67.4±12.9 岁，P<0.0001），且合并症更多。ACS 类型与 HIV 状态无显著差异。感染 HIV 的人接受冠状动脉造影的可能性较低（35.2% vs. 37.2%，调整后的 OR 0.87，95%CI 0.83-0.92，P<0.0001），且同时患有 HIV 和 STEMI 的人接受药物洗脱支架的比例较低（60.1% vs. 68.5%，调整后的 OR 0.81，95%CI 0.68-0.96，P=0.016）。感染 HIV 的人调整后的住院死亡率（OR 1.29，95%CI 1.15-1.44；P<0.0001）、30 天再入院率（OR 1.18，95%CI 1.09-1.27；P<0.0001）和 12 个月死亡率（OR 1.32，95%CI 1.22-1.44；P<0.0001）均较高。出院后 12 个月，PLWH 开具心脏药物的比例较低。
在因 ACS 住院的当代人群中，PLWH 接受的指南支持的介入和药物治疗较少，临床结局较差。需要针对这一独特人群制定优化治疗策略。
