Abstract 18446: Receipt of Implantable Cardioverter-Defibrillator Among HIV+ and HIV- Veterans With Cardiomyopathy

Abstract

Introduction: Those with HIV infection (HIV+) are at increased risk for AMI, CHF, and sudden cardiac death compared to uninfected individuals (HIV-). HIV+ people also receive fewer cardiac procedures for AMI than HIV- people. Whether those with HIV with cardiomyopathy (CM) and low ejection fraction (EF) receive fewer implantable cardioverter defibrillators (ICD) compared to HIV- people with CM is not known. Hypothesis: We hypothesized (1) that HIV+ veterans with CM who qualify for an ICD (EF≤ 35%, NYHA II-III) will receive proportionally fewer ICDs than uninfected people with CM and (2) among those not receiving an ICD, mortality rates will be the highest for those with HIV infection. Methods: We analyzed data on 626 participants (44% HIV+) from the Veterans Aging Cohort Study Virtual Cohort, a prospective longitudinal of HIV+ and 1:2 matched HIV- Veterans, who were free of prevalent cardiovascular disease at study enrollment (n=97,685) and experienced an incident CM event with an associated EF ≤35% and/or left ventricular EF described as moderately to severely reduced between 2003-2009. Chi square testing was used to determine difference in the proportion of receipt of an ICD by HIV status. We calculated age and race adjusted mortality rates by HIV and ICD status. Results: Of the 626 participants with CM and low EF, 8.7% of HIV+ and 14.3% of HIV- patients received an ICD (p=0.04). Mortality rates (per 1000 person years) were: HIV+ no ICD (134, 95% CI=101-183), HIV+ with ICD (100, 95% CI=59-171), HIV- no ICD (73, 95% CI=53-103), HIV- with ICD (55, 95% CI=32-95). Among HIV+ and HIV-, there was no difference in mortality by ICD placement, p=0.66 and p=0.27, respectively. Mortality rates by HIV and ICD status over time are presented in Figure 1. Conclusions: Among Veterans with cardiomyopathy and low EF, receipt of ICD was lower among HIV+ compared to HIV- Veterans. Although not statistically significant, mortality rates were higher among those not receiving ICD, regardless of HIV status.