Prescription Patterns of Guideline Directed Therapies And Clinical Outcomes In Patients With Heart Failure, Based on Human Immunodeficiency Virus Status

Abstract

Introduction Patients with human immunodeficiency virus (HIV) are living longer due to advancements in antiretroviral therapies. Subsequently, people with HIV are developing chronic conditions such as heart failure (HF) which they tend to develop earlier in life. The purpose of this study is to evaluate prescription patterns of guideline directed medical therapy (GDMT) and clinical outcomes among HF patients with reduced EF (HFrEF), with and without HIV. Methods We retrospectively investigated electronic health records from 123 patients 18 years and older with HFrEF (n=82) matched 2:1 by HF diagnosis date to those with both HFrEF and HIV (n=41). This study was conducted in a large, academic medical center including records from January 1, 2013 to January 1, 2019. Baseline demographics, such as comorbidities, anthropometric, and metabolic parameters; prescription data; and healthcare utilization were evaluated at year 1 and 2 after HFrEF diagnosis. The primary endpoint was a composite of GDMT prescriptions for HFrEF: angiotensin modulator (AM - angiotensin converting enzyme inhibitor, angiotensin II receptor blocker or angiotensin receptor-neprilysin inhibitor); beta-blocker; or aldosterone antagonist. Secondary endpoints were HF-related events including hospitalization for HF and outpatient clinic visits. Results Compared to patients with HFrEF, those with HFrEF and HIV were younger (50±11 vs 56±14 years, p Conclusions Results from this single-center study provide insight into the current treatment and management of HFrEF in patients with HIV. This vulnerable population may receive less aggressive GDMT, especially during their first year after HFrEF diagnosis, which could be driving increased hospitalizations. Furthermore, these patients may face additional factors that affect their care, such as chronic kidney disease and racial disparities.