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Congestive heart failure in persons living
with HIV: are we providing standard of care?
Most People With HIV and CHF Get Correct CHF Care-With Notable Exceptions
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IDWeek 2020, October 22-25, 2020
Mark Mascolini
A chart review of 79 HIV-positive people with congestive heart failure (CHF) found that most did receive the standard of care spelled out by American College of Cardiology/American Heart Association (ACC/AHA) guidelines [1]. But notable exceptions to this rule emerged. For example, one third of people with hypertension did not get guideline-based titrated therapy, and more than 40% who had heart failure with preserved ejection fraction (HFrEF) did not receive proper antihypertensive therapy.
Researchers at Rutgers New Jersey Medical School noted that people living longer with HIV face a growing risk of cardiovascular disease including CHF. They conducted this chart review to see if HIV-positive CHF patients at a large university-affiliated hospital received CHF standard care defined by 2017 ACC/AHA guidelines.
Among 154 charts for people with HIV and CHF, the Rutgers team found 79 eligible for this analysis. They excluded people managed elsewhere for CHF, people misdiagnosed, and people who died. Seventy participants were diagnosed with heart failure with reduced ejection fraction (HFrEF), meaning an ejection fraction below 40%; and 9 were diagnosed with heart failure with preserved ejection fraction (HFpEF), meaning an ejection fraction above 50%.
First the researchers scrutinized care of the 70 people with HFrEF. Among 60 people who should have received guideline-advised treatment with aldosterone antagonists and beta blockers, 9 (15%) did not. (Ten percent eligible for aldosterone antagonists did not get them because of an incorrect contraindication.) Among 37 people who should have been considered for treatment with a device, 14 (38%) were not. Among 70 people assessed for receiving treatment according to a documented NYHA/ACC/AHA class, 13 (19%) did not have their CHF class documented. And among 49 people with hypertension who should have received guideline-directed medications for heart failure (GDMT) titrated to achieve a systolic blood pressure below 130 mm Hg, 17 (35%) did not.
Next the investigators turned to the 9 people diagnosed with HFpEF. All 5 who should have been prescribed diuretics got a prescription. Among 9 people who should have received exercise counseling or a physical therapy referral, 3 (33%) did not. And among 7 people who needed guideline-based therapy for hypertension, 3 (43%) did not get guideline-based therapy.
The Rutgers team stressed three areas in which clinicians can improve management of CHF in people with HIV: (1) documenting heart failure class, (2) correctly interpreting contraindications to medications, and (3) considering use of recommended therapeutic devices.
Reference
1. Chowdhury S, Seo J, Keller S, Solanki P, Finkel D. Congestive heart failure in persons living with HIV: are we providing standard of care? IDWeek 2020, October 22-25, 2020. Abstract 931.
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