Association of HIV Infection and Antiretroviral Therapy With Sudden Cardiac Death
Background: HIV infection potentially increases coronary artery disease and heart failure risks. However, the association between HIV infection and sudden cardiac death (SCD) has not been extensively studied. This nationwide cohort study aimed to determine SCD risks in Taiwanese patients with and without HIV infection. Methods: Adult people living with HIV/AIDS (PLWHA) since January 1, 2003, were identified from the Taiwan Centers for Disease Control HIV surveillance system. HIV-infected individuals were defined as positive HIV-1 Western blot. A control cohort without HIV infection, matched for age and sex, was selected for comparison from the Taiwan National Health Insurance Research Database. All patients were followed up until SCD, mortality for another cause, or till December 31, 2014. A time-dependent Cox proportional hazards model was used to determine the association of HIV and antiretroviral therapy (ART) with SCD. Results: During a mean 5.86-year follow-up, 5342 (4.40%) of 121,530 patients (24,306 PLWHA and 97,224 matched controls) died; among them, 150 (0.12%) died of SCD. Among 150 SCD events, 97 (64.7%) and 53 (33.3%) occurred in PLWHA and controls, respectively, which corresponded to incidences of 68.31 in PLWHA and 9.31 per 100,000 person-years in controls (P
ConclusionsPatterns of high prescribing to older patients is common and measurable at the physician level. Addressing high outlier prescribers may represent an opportunity to reduce avoidable harm and excessive costs.
Conditions: HIV/AIDS; Heart Failure With Preserved Ejection Fraction Interventions: Drug: Sacubitril-Valsartan 49-51Mg Oral Tablet; Drug: Placebo oral tablet Sponsor: Massachusetts General Hospital Not yet recruiting
Robert Chelsea turned down the first face he was offered. It was a fine face, one that could have taken him off the transplant waiting list after just a couple months. But Chelsea—severely disfigured after a catastrophic car accident five years earlier—was in no hurry. He’d gotten used to tilting his head back so food and water wouldn’t fall out of his nearly lipless mouth. He knew how to respond compassionately to children who stared in shock and fear. The face, offered in May 2018, had belonged to a man with skin that was much fairer than what remained of Chelsea’s—so light that Chelse...
AbstractPurposePeople with HIV (PHIV) with access to modern antiretroviral therapy (ART) face a two-fold increased risk of heart failure as compared with non-HIV-infected individuals. The purpose of this review is to consider evolving risks, mechanisms, and preventive considerations pertaining to heart failure among PHIV.Recent FindingsWhile unchecked HIV/AIDS has been documented to precipitate heart failure characterized by overtly reduced cardiac contractile function, ART-treated HIV may be associated with either heart failure with reduced ejection fraction (HFrEF) or with heart failure with preserved ejection fraction (...
The risk of sudden cardiac death (SCD) appears to be higher among heart failure patients who also have HIV infection, according to new findings.Reuters Health Information
Nearly one in five patients recently admitted to the hospital for heart failure (HF) will die within 30 days of discharge. Despite this poor prognosis, most do not recall discussing end of life preferences with a health care provider. Advance care planning (ACP) helps to ensure that patients receive care that aligns with their goals and wishes and helps engage them in shared decision making with providers in an ongoing and iterative process. The 2017 American College of Cardiology Pathway for Optimization of HF Treatment recommends the use of patient decision aids followed by personalized ACP conversations.
ConclusionsIntravenous iron therapy with FCM is associated with early reductions in PVS and weight, implying that decongestion might be one mechanism via which iron repletion aids CHF patients. Calculated PVS is of prognostic utility in this cohort.