Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV
Background People living with HIV (PHIV) are at an increased risk for sudden cardiac death, and implantable cardioverter‐defibrillators (ICDs) prevent SCD. There are no data on the incidence, predictors, and effects of ICD therapies among PHIV. Methods and Results We compared ICD discharge rates bet...
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| Language: | English |
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Wiley
2018-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009857 |
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| author | Raza M. Alvi Anne M. Neilan Noor Tariq Magid Awadalla Adam Rokicki Malek Hassan Maryam Afshar Connor P. Mulligan Virginia A. Triant Markella V. Zanni Tomas G. Neilan |
| author_facet | Raza M. Alvi Anne M. Neilan Noor Tariq Magid Awadalla Adam Rokicki Malek Hassan Maryam Afshar Connor P. Mulligan Virginia A. Triant Markella V. Zanni Tomas G. Neilan |
| author_sort | Raza M. Alvi |
| collection | DOAJ |
| description | Background People living with HIV (PHIV) are at an increased risk for sudden cardiac death, and implantable cardioverter‐defibrillators (ICDs) prevent SCD. There are no data on the incidence, predictors, and effects of ICD therapies among PHIV. Methods and Results We compared ICD discharge rates between 59 PHIV and 267 uninfected controls. For PHIV, we tested the association of traditional cardiovascular risk factors and HIV‐specific parameters with an ICD discharge and then tested whether an ICD discharge among PHIV was associated with cardiovascular mortality or an admission for heart failure. The indication for ICD insertion was similar among groups. Compared with controls, PHIV with an ICD were more likely to have coronary artery disease and to use cocaine. In follow‐up, PHIV had a higher ICD discharge rate (39% versus 20%; P=0.001; median follow‐up period, 19 months). Among PHIV, cocaine use, coronary artery disease, QRS duration, and higher New York Heart Association class were associated with an ICD discharge. An ICD discharge had a prognostic effect, with a subsequent 1.7‐fold increase in heart failure admission and a 2‐fold increase in cardiovascular mortality, an effect consistent across racial/ethnic and sex categories. Conclusions ICD discharge rates are higher among PHIV compared with uninfected controls. Among PHIV, cocaine use and New York Heart Association class are associated with increased ICD discharge, and an ICD discharge is associated with a subsequent increase in admission for heart failure and cardiovascular mortality. |
| format | Article |
| id | doaj-art-a04a80eb24b3497fb8c481cdab29e1aa |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2018-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-a04a80eb24b3497fb8c481cdab29e1aa2025-08-20T03:07:46ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-09-0171810.1161/JAHA.118.009857Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIVRaza M. Alvi0Anne M. Neilan1Noor Tariq2Magid Awadalla3Adam Rokicki4Malek Hassan5Maryam Afshar6Connor P. Mulligan7Virginia A. Triant8Markella V. Zanni9Tomas G. Neilan10Cardiac MR PET CT Program Department of Radiology and Division of Cardiology Massachusetts General Hospital Harvard Medical School Boston MADivision of Infectious Diseases Department of Medicine and Department of Pediatrics Massachusetts General Hospital Harvard Medical School Boston MAYale New Haven Hospital of Yale University School of Medicine New Haven CTCardiac MR PET CT Program Department of Radiology and Division of Cardiology Massachusetts General Hospital Harvard Medical School Boston MACardiac MR PET CT Program Department of Radiology and Division of Cardiology Massachusetts General Hospital Harvard Medical School Boston MACardiac MR PET CT Program Department of Radiology and Division of Cardiology Massachusetts General Hospital Harvard Medical School Boston MABronx‐Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai Bronx NYCardiac MR PET CT Program Department of Radiology and Division of Cardiology Massachusetts General Hospital Harvard Medical School Boston MADivisions of Infectious Diseases and General Internal Medicine Department of Medicine Massachusetts General Hospital Harvard Medical School Boston MAProgram in Nutritional Metabolism Massachusetts General Hospital Harvard Medical School Boston MACardiac MR PET CT Program Department of Radiology and Division of Cardiology Massachusetts General Hospital Harvard Medical School Boston MABackground People living with HIV (PHIV) are at an increased risk for sudden cardiac death, and implantable cardioverter‐defibrillators (ICDs) prevent SCD. There are no data on the incidence, predictors, and effects of ICD therapies among PHIV. Methods and Results We compared ICD discharge rates between 59 PHIV and 267 uninfected controls. For PHIV, we tested the association of traditional cardiovascular risk factors and HIV‐specific parameters with an ICD discharge and then tested whether an ICD discharge among PHIV was associated with cardiovascular mortality or an admission for heart failure. The indication for ICD insertion was similar among groups. Compared with controls, PHIV with an ICD were more likely to have coronary artery disease and to use cocaine. In follow‐up, PHIV had a higher ICD discharge rate (39% versus 20%; P=0.001; median follow‐up period, 19 months). Among PHIV, cocaine use, coronary artery disease, QRS duration, and higher New York Heart Association class were associated with an ICD discharge. An ICD discharge had a prognostic effect, with a subsequent 1.7‐fold increase in heart failure admission and a 2‐fold increase in cardiovascular mortality, an effect consistent across racial/ethnic and sex categories. Conclusions ICD discharge rates are higher among PHIV compared with uninfected controls. Among PHIV, cocaine use and New York Heart Association class are associated with increased ICD discharge, and an ICD discharge is associated with a subsequent increase in admission for heart failure and cardiovascular mortality.https://www.ahajournals.org/doi/10.1161/JAHA.118.009857heart failureHIVimplantable cardioverter‐defibrillator dischargeimplantable cardioverter‐defibrillator |
| spellingShingle | Raza M. Alvi Anne M. Neilan Noor Tariq Magid Awadalla Adam Rokicki Malek Hassan Maryam Afshar Connor P. Mulligan Virginia A. Triant Markella V. Zanni Tomas G. Neilan Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure HIV implantable cardioverter‐defibrillator discharge implantable cardioverter‐defibrillator |
| title | Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV |
| title_full | Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV |
| title_fullStr | Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV |
| title_full_unstemmed | Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV |
| title_short | Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV |
| title_sort | incidence predictors and outcomes of implantable cardioverter defibrillator discharge among people living with hiv |
| topic | heart failure HIV implantable cardioverter‐defibrillator discharge implantable cardioverter‐defibrillator |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009857 |
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