Coronary artery disease
Comparison of In-Hospital Mortality from Acute Myocardial Infarction in HIV Sero-Positive Versus Sero-Negative Individuals

https://doi.org/10.1016/j.amjcard.2012.05.045Get rights and content

Few studies have explored hospitalization outcome differences between patients who are seropositive for human immunodeficiency virus (HIV) compared to HIV-seronegative patients with acute myocardial infarctions (AMIs). The aim of this study was to explore in-hospital AMI mortality risk in seropositive and seronegative patients. A secondary analysis of the Nationwide Inpatient Sample from 1997 to 2006 was conducted. This sample allows the approximation of all United States hospitalizations. All AMI encounters with and without co-occurring HIV were identified using appropriate International Classification of Diseases and procedure codes. Descriptive and Cox proportional-hazards analyses were then conducted to estimate mortality differences between seropositive and seronegative patients while adjusting for demographic, clinical, hospital, and care factors. The results demonstrated higher AMI hospitalization mortality hazard in seropositive compared to seronegative patients after adjustment for age, gender, ethnicity, medical co-morbidities, hospital type, and number of in-hospital procedures (HR 1.38, 95% confidence interval 1.01 to 1.87, p = 0.04). Stratified analysis demonstrated greater although not statistically significant mortality hazard for non–ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction in seropositive compared to seronegative patients. Typical AMI care procedures occurred at significantly lower rates in seropositive versus seronegative patients, including thrombolytic and anticoagulant agents (18% vs 22%), coronary arteriography (48% vs 63%), left cardiac catheterization (52% vs 66%), and coronary artery bypass graft (6% vs 14%). In conclusion, additional mortality burden and lower procedure rates occur for HIV-seropositive patients receiving AMI care. Health care providers should be alert to the increased mortality burden when treating seropositive patients with AMI.

Section snippets

Methods

Data were obtained from the Nationwide Inpatient Sample (NIS), developed as part of the Healthcare Cost and Utilization Project, a federal-state-industry partnership sponsored by the Agency for Healthcare Research and Quality. The NIS is designed to approximate a stratified 20% sample of all nonfederal, short-term, general, and specialty hospitals serving adults in the United States. The sampling strategy selects hospitals nationwide from the state inpatient database according to defined strata

Results

The frequency and distribution of all study variables are listed in Table 1. The results demonstrate that most in-hospital encounters for AMI were in patients aged ≥55 years who were white, male, and privately insured. Most AMI encounters occurred in patients with CCI scores ≤2, and the mean length of hospital stay was 5.29 days (SE 0.03). The most common medical co-morbidities for patients with AMI were hypertension (51.0%), diabetes without complications (23.6%), congestive heart failure

Discussion

Our study demonstrates that the relative in-hospital mortality risk from an AMI event was significantly higher for seropositive compared to seronegative patients. This risk remained significantly higher even after accounting for the influence of demographics, medical co-morbidities, hospital type, dyslipidemia, and number of in-hospital procedures. Although it is difficult to determine the causes for the observed disproportionate mortality outcome, an underlying increased co-morbidity burden,

References (28)

  • C. Ani et al.

    Age- and sex-specific in-hospital mortality after myocardial infarction in routine clinical practice

    Cardiol Res Pract

    (2010)
  • H. Quan et al.

    Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data

    Med Care

    (2005)
  • M. Battegay et al.

    Morbidity and mortality in HIV-infected individuals—a shift towards comorbidities

    Swiss Med Wkly

    (2009)
  • S. Matetzky et al.

    Acute myocardial infarction in human immunodeficiency virus-infected patients

    Arch Intern Med

    (2003)
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