Coronary revascularization for acute myocardial infarction in the HIV population

Singh, Vikas; Mendirichaga, Rodrigo; Savani, Ghanshyambhai T.; Rodríguez, Alexis; Dabas, Nitika; Munagala, Anish; Alfonso, Carlos; Cohen, Mauricio G.; Elmariah, Sammy; Palacios, Igor F.

doi:10.1111/joic.12433

Cited by 24 publications

(20 citation statements)

References 17 publications

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“…4 Some studies have noted a conservative treatment bias for such patients. 8,9 It is unclear, though, if AMI management bias persists for HIV patients using more recent data, or whether such bias translates into an appreciable inhospital mortality difference. We conducted this observational study to evaluate practice patterns and inpatient outcomes of patients with seropositive HIV infection, presenting with AMI compared with the general non-HIV population.…”

Section: Introductionmentioning

confidence: 99%

Treatment Bias in Management of HIV Patients Admitted for Acute Myocardial Infarction: Does It Still Exist?

Ogunbayo

Ahmad

et al. 2019

J GEN INTERN MED

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Section: Introductionmentioning

confidence: 99%

Treatment Bias in Management of HIV Patients Admitted for Acute Myocardial Infarction: Does It Still Exist?

Ogunbayo

Ahmad

et al. 2019

J GEN INTERN MED

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“…Similar findings of increased costs have also been observed in several other studies in patients with HIV undergoing various procedures. 37,38 This may be due to additional medications being needed and the increased risk of infection in this population. 39 This population of patients is also younger without many of the same risk factors found typically in patients with PAD, which may delay recognition and workup prior to revascularization.…”

Section: Discussionmentioning

confidence: 99%

Trends and perioperative outcomes of patients with human immunodeficiency virus (HIV) undergoing lower extremity revascularization

et al. 2020

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The development of highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with human immunodeficiency virus (HIV), but has led to the rise of chronic conditions including peripheral artery disease (PAD). However, trends and outcomes among patients with HIV undergoing lower extremity revascularization are poorly characterized. The aim of this study was to investigate the trends and perioperative outcomes of lower extremity revascularization among patients with HIV and PAD in a national database. The National Inpatient Sample (NIS) was reviewed between 2003 and 2014. All hospital admissions with a diagnosis of PAD undergoing lower extremity revascularization were stratified based on HIV status. Outcomes were assessed using propensity score matching and multivariable regression. Among all patients undergoing lower extremity revascularization for PAD, there was a significant increase in the proportion of patients with HIV from 0.21% in 2003 to 0.52% in 2014 ( p < 0.01). Patients with HIV were more likely to be younger, male, and have fewer comorbidities, including coronary artery disease and diabetes, at the time of intervention compared to patients without HIV. With propensity score matching and multivariable regression, HIV status was associated with increased total hospital costs, but not length of stay, major amputation, or mortality. Patients with HIV with PAD who undergo revascularization are younger with fewer comorbidities, but have increased hospital costs compared to those without HIV. Lower extremity revascularization for PAD is safe for patients with HIV without increased risk of in-hospital major amputation or mortality, and continues to increase each year.

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“…The study was conducted between January 2018 and May 2018 with the use of the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. The NIS is the largest publicly available database on all-payer administrative claims in the United States and has been extensively used to analyze trends in cardiovascular care [11, 12]. NIS data from January 2005 through December 2011 were included in the study.…”

Section: Methodsmentioning

confidence: 99%

Association between Public Reporting of Outcomes and the Use of Mechanical Circulatory Support in Patients with Cardiogenic Shock

Singh

Mendirichaga

Bhatt

et al. 2019

Journal of Interventional Cardiology

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Risk-averse behavior has been reported among physicians and facilities treating cardiogenic shock in states with public reporting. Our objective was to evaluate if public reporting leads to a lower use of mechanical circulatory support in cardiogenic shock. We conducted a retrospective study with the use of the National Inpatient Sample from 2005 to 2011. Hospitalizations of patients ≥18 years old with a diagnosis of cardiogenic shock were included. A regional comparison was performed to identify differences between reporting and nonreporting states. The main outcome of interest was the use of mechanical circulatory support. A total of 13043 hospitalizations for cardiogenic shock were identified of which 9664 occurred in reporting and 3379 in nonreporting states (age 69.9 ± 0.4 years, 56.8% men). Use of mechanical circulatory support was 32.8% in this high-risk population. Odds of receiving mechanical circulatory support were lower (OR 0.50; 95% CI 0.43–0.57; p<0.01) and in-hospital mortality higher (OR 1.19; 95% CI 1.06–1.34; p<0.01) in reporting states. Use of mechanical circulatory support was also lower in the subgroup of patients with acute myocardial infarction and cardiogenic shock in reporting states (OR 0.61; 95% CI 0.51–0.72; p<0.01). In conclusion, patients with cardiogenic shock in reporting states are less likely to receive mechanical circulatory support than patients in nonreporting states.

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Coronary revascularization for acute myocardial infarction in the HIV population

Abstract: Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States.

Cited by 24 publications

References 17 publications

Treatment Bias in Management of HIV Patients Admitted for Acute Myocardial Infarction: Does It Still Exist?

Treatment Bias in Management of HIV Patients Admitted for Acute Myocardial Infarction: Does It Still Exist?

Trends and perioperative outcomes of patients with human immunodeficiency virus (HIV) undergoing lower extremity revascularization

Association between Public Reporting of Outcomes and the Use of Mechanical Circulatory Support in Patients with Cardiogenic Shock

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