Heart failure among people with HIV: prescription of guideline-directed medical therapy.

Background

People with HIV have an increased risk of heart failure (HF) compared to people without HIV. Guideline-directed medical therapy (GDMT) is the cornerstone of HF management, but little is known about GDMT prescription in this high-risk population.

Objective

To evaluate GDMT intensity and identify patient factors associated with optimal HF therapy among people with HIV and systolic HF.

Methods

We conducted retrospective analyses of the PATHWAYS study, a multi-institutional study of underrepresented racial and ethnic minorities with HIV. Adult patients with systolic HF (by ICD code) were included. A composite GDMT score was constructed using dosage-weighted prescription of GDMT drugs, ranging from 0% to 100% (with 100% indicating optimal therapy).

Results

Among 451 PWH with systolic HF, the median age was 54 years (IQR = 47-62), 34.6% were female, and 96.6% were Black. In the year after HF diagnosis, 85.8% of patients were prescribed any GDMT, and 45.5% of patients attended a cardiology clinic visit. The mean GDMT score was 30% (SD = 22%). In multivariable analyses, lower GDMT scores occurred among patients with older age (adjusted mean ratio [AMR] = 0.96, 95% CI: 0.93-0.99) and severe renal disease (AMR = 0.84, 95% CI: 0.71-0.99). Higher GDMT scores occurred among patients with diabetes mellitus (AMR = 1.33, 95% CI: 1.16-1.53), prior myocardial infarction (AMR = 1.17, 95% CI: 1.02-1.35), and those who attended a cardiology clinic visit (AMR = 1.29, 95% CI: 1.13-1.47).

Conclusions

People with HIV and HF had low GDMT scores, suggesting suboptimal intensity of HF care. Cardiology clinic attendance was associated with higher GDMT scores.