The Risk of and Survival with Preserved vs Reduced Ejection Fraction Heart Failure by HIV Status
Matthew Freiberg1, C-C Chang1, KA Oursler2,3, J Gottdiener4, S Gottlieb4, A Warner5, D Leaf5, M Rodriguez-Barradas6,7, S Felter8, A Butt1,9, and VACS Project Team
1Univ of Pittsburgh Sch of Med, PA, US; 2Baltimore VAMC, MD, US; 3Univ of Maryland Sch of Med, Baltimore, US; 4Univ of Maryland Med Ctr, Baltimore, US; 5VA Greater Los Angeles Hlthcare System, CA, US; 6Baylor Coll of Med, Houston, TX, US; 7Michael E DeBakey VAMC, Houston, TX, US; 8VA Pittsburgh Hlthcare System, PA, US; and 9Sheikh Khalifa Med City, Abu Dhabi, United Arab Emirates
Background: HIV is associated with an increased risk of heart failure (HF). Whether this risk is specific to HF with preserved ejection fraction (PEF) vs reduced ejection fraction (REF), and whether survival differs between HFPEF and HFREF among HIV+ people is unknown.
Methods: We analyzed data on 80,226 (33% HIV+) participants in the Veterans Aging Cohort Study-Virtual Cohort (VACS-VC). VACS-VC consists of a sample of HIV+ people each matched on age, gender, race/ethnicity, and clinical site to 2 uninfected veterans also in care. After restricting the sample to those free of baseline cardiovascular disease, we analyzed data on HIV status, age, gender, race/ethnicity, hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, atrial flutter, hepatitis C infection, body mass index, renal disease, anemia, substance use, and incidence of total HF, HFPEF, and HFREF from October 2003-January 2010. HF was determined by International Classification of Diseases, 9th revision (ICD-9) codes and EF was assessed from echocardiographic data abstracted from medical records. A reduced EF was <40% and preserved EF was ≥40%.
Results: During a median follow-up of 5.9 years, there were 1250 HF events (41% among HIV+). Of these events, 55% were HFPEF; 33% were HFREF; and 12% were unknown type (i.e., no echocardiographic data was available). There was no difference in these proportions by HIV status. HF rates per 1000 person-years and risks of specific types of HF by HIV status are presented in the Table 1. Among those with HF, rates (95% confidence intervals [CI]) of total mortality per 1000 person-years by type of HF and HIV status were as follows: uninfected HFPEF, 45.4 (37.5-55.0); uninfected HFREF, 54.8 (43.1-69.6); HIV+ HFPEF, 90.1 (75.3-107.7); HIV+ HFREF, 103.9 (84.5-127.8); uninfected unknown type, 16.0 (15.5-16.4); HIV+ unknown type, 39.1 (38.0-40.2). HIV+ Veterans with HF had higher rates of mortality than uninfected veterans but survival did not differ by HF type (p = 0.15).
Conclusions: HIV infection is associated with an increased risk of HFPEF and HFREF. Among those with HF, HIV+ veterans had higher rates of mortality but survival did not differ significantly by type of heart failure.