Low Adherence to Guidelines for Cardiovascular Care in HIV

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Physicians in the United States generally underused current cardiovascular care guidelines for patients infected with HIV.
Physicians in the United States generally underused current cardiovascular care guidelines for patients infected with HIV.

Recommended guidelines for cardiovascular care of patients infected with HIV are underused by physicians, according to data published in the Journal of the American Heart Association.

Data from physician visits by 1631 HIV-infected individuals and 226,862 uninfected patients, aged 40 to 79 years, with cardiovascular risk factors were analyzed. The outcome was provision of guideline-recommended care, and data were adjusted for clinical and demographic factors.

The proportion of visits by HIV-infected adults who received the guideline-recommended treatment was lower vs HIV-uninfected adults for aspirin/antiplatelet therapy, at 5.1% vs 13.8% (P =.03), and for statin therapy, at 23.6% vs 35.8% (P <.01), respectively.

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There were no differences in guideline-recommended treatment in antihypertensive medication therapy (53.4% vs 58.6%), diet/exercise counseling (14.9% vs 16.9%), or smoking cessation advice/pharmacotherapy (18.8% vs 22.4%) between HIV-infected and uninfected patients, respectively.

According to the study researchers, US physicians are underusing guideline-recommended cardiovascular care for high-risk patients and are less likely to prescribe aspiring and statins to HIV-infected patients.

These results "may partially explain higher rates of adverse cardiovascular events among patients with HIV." However, rates of prescriptions and counseling may be underestimated because of underreporting and the availability of aspirin over the counter. Stratified analysis of data by insurance status or income was also not possible in this study because of sample size limitations, and should be considered in future work.

To date, few studies have investigated physician cardiovascular care patterns, and although differences in aspirin and statin prescription rates likely do not play as large a role as other factors such as smoking or HIV-related information, they represent an area where improvements can be made.

Reference

Ladapo JA, Richards AK, DeWitt CM, et al. Disparities in the quality of cardiovascular care between HIV-infected versus HIV-uninfected adults in the United States: a cross-sectional studyJ Am Heart Assoc. 2017;6:e007107. 

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