Background: The improved life expectancy observed in patients living with Human Immunodeficiency Virus (HIV) infection has made age-related cardiovascular complications, including arrhythmias, a growing health concern. We describe the temporal trends in frequency of various arrhythmias and assess impact of arrhythmias on hospitalized HIV patients using the Nationwide Inpatient Sample (NIS) Methods and Results: Data on HIV-related hospitalizations from 2005 to 2014 were obtained from the NIS using International Classification of Diseases, 9th Revision (ICD-9) codes. Data was further subclassified into hospitalizations with associated arrhythmias and those without arrhythmia. Baseline demographics and comorbidities were determined. Outcomes including in-hospital mortality, cost of care, and length of stay were extracted. SAS 9.4 (SAS Institute Inc., Cary, North Carolina) was utilized for analysis. A multivariable analysis was performed to identify predictors of arrhythmias among hospitalized HIV patients. Among 2,370,751 HIV-related hospitalizations identified, the overall frequency of any arrhythmia was 3.01%. Atrial fibrillation (AF) was the most frequent arrhythmia (2110 per 100,000). The overall frequency of arrhythmias has increased over time by 108%, primarily due to a 132% increase in AF. Arrhythmias are more frequent among older males, lowest income quartile and non-elective admissions. Patients with arrhythmias had a higher in-hospital mortality rate (9.6%). In-hospital mortality among patients with arrhythmias has decreased over time by 43.8%. The cost of care and length of stay associated with arrhythmia-related hospitalizations were mostly unchanged. Conclusions: Arrhythmias are associated with significant morbidity and mortality in hospitalized HIV patients. AF is the most frequent arrhythmia in hospitalized HIV patients.

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Elevated single BNP measurements after cardiac transplantation have been reported to predict cardiac rejection. The physiology behind elevated BNP may be due to volume overload, restrictive cardiac physiology, or rejection. It is not known what is the significance of persistently elevated BNP levels in the first year after heart transplantation.MethodsWe reviewed 107 heart transplant patients between July 2001 and November 2003 who had 2348 BNP blood samples obtained from the time of transplant. A mean first-year BNP level was obtained by averaging at least 4 blood samples (2 blood samples before and after the 6 month post-transplant period). Samples during allograft rejection, hemodialysis, and during the first 2 months (during which levels are known to be elevated) were excluded. The patients were divided into two groups: low BNP (n = 75, those with first-year mean BNP less than 140 ng/mL) and high BNP (n = 32, those with first-year mean BNP greater than 140 ng/mL).ResultsCompared to the low-BNP group, patients with high BNP had a significantly greater incidence of cardiac allograft vasculopathy (4% vs 22%), any hemodynamic compromising rejection (4% vs 31%), and mortality (1.4% vs 12%) (all comparisons p < .05) over an average follow-up of 28 months. There was no difference in mean echocardiographic ejection fraction between the two groups (LVEF 54.6% vs 52.2%, p = .08).ConclusionPersistently elevated BNP in the first year after heart transplant appears to be an early marker for poor outcome. Further studies into the management and actual cause of persistently elevated BNP following cardiac transplantation need to be performed.

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