Treatment Bias in Management of HIV Patients Admitted for Acute Myocardial Infarction: Does It Still Exist?
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Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA; 2New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA; 3Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA; 4Wyckoff Heights Medical Center, New York, NY, USA; 5 University of Texas Medical Branch, Galveston, TX, USA; 6Department of Cardiology, INSERM, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France.
INTRODUCTION: Previous studies have reported lower rates of coronary angiography and revascularization, and significantly higher mortality among patients infected with human immunodeficiency virus (HIV) presenting with acute myocardial infarction (AMI). This observational study was designed to evaluate characteristics and inpatient outcomes of patients with seropositive HIV infection presenting with AMI. METHODS: Using the National Inpatient Sample (NIS) database, we identified patients (admissions) with a primary diagnosis of myocardial infarction and a co-occurring HIV. We described baseline characteristics and outcomes. Our primary outcomes of interest were prevalence of coronary angiography, revascularization (percutaneous coronary intervention (PCI) or CABG), and mortality. RESULTS: From 2010 to 2014, of about 2,977,387 patients with a primary diagnosis of AMI, 10,907 (0.4%) were HIV seropositive. Patients with HIV were younger and more likely to be African American or Hispanic. Coronary angiography and revascularization were performed more frequently in the HIV population. The higher prevalence of revascularization was driven by a higher incidence of PCI. In a multivariable model, patients with HIV were no more likely to undergo revascularization than the general population. This was also the case for PCI. Unadjusted all-cause mortality was lower among patients with HIV. After controlling for confounders, this finding was not significant (OR 0.97, 95% CI 0.75–1.25, p = 0.79). The length of stay between both groups was comparable. CONCLUSION: In this current analysis, we did not note any treatment bias or difference in the rate of in-hospital total mortality for HIV-seropositive patients presenting with AMI compared with the general population. KEY WORDS: human immunodeficiency virus; acute myocardial infarction; revascularization. J Gen Intern Med DOI: 10.1007/s11606-019-05416-6 © Society of General Internal Medicine 2019
Gbolahan O. Ogunbayo and Le Dung Ha are co-first authors. Received November 30, 2018 Revised May 30, 2019 Accepted August 27, 2019
INTRODUCTION
In 2013, the United Nations (UN) reported an estimation of 35.3 (32.2–38.8) million people worldwide living with human immunodeficiency virus (HIV) with an annual incidence of 2.3 (1.9–2.7) million new HIV infection cases.1 While transmission of HIVencouragingly halved between 2001 and 2012, the infectious disease remains a significant morbidity and mortality burden to global health care. Traditionally, the majority of deaths in HIV patients could be attributed to HIV-related diseases, with cardiovascular dise
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