Traditional and HIV-specific Risk Factors Are Associated with Incident Non-valvular Atrial Fibrillation and Atrial Flutter among Underrepresented Racial and Ethnic Minority Groups Living with HIV
Abstract Body (Do not enter title and authors here): Introduction: With effective antiretroviral therapy (ART), HIV can now be managed as a chronic disease. Chronic disease and cardiovascular risk factor management is especially important for underrepresented racial and ethnic minority groups (UREG). Non-valvular atrial fibrillation and atrial flutter (NVAF) have not been adequately studied in UREG with HIV. Research Questions: Among UREG with HIV, what is the incidence of NVAF? What factors are associated with incident NVAF? Aims: To narrow an evidence gap among UREG with HIV by 1) describing the incidence of NVAF and 2) identifying factors associated with incident NVAF. Methods: This is an ancillary study of the Pathways to Cardiovascular Disease Prevention and Impact of Specialty Referral in Underrepresented Racial and Ethnic Minorities with HIV (PATHWAYS) study, a retrospective population-based study of HIV care patterns among UREG with HIV. Patients without a known history of NVAF entered our study cohort at the date of their first documented HIV diagnosis. We computed the cumulative incidence of NVAF over five years of follow-up (mean 3.4, SD 1.6), handling death as a competing risk. Cox regression analysis was used to examine the univariate associations between characteristics at HIV diagnosis and incident NVAF, adjusting for site and date of HIV diagnosis. Results: From 2015-2019, 10,945 UREG meeting entry criteria were identified. On average, patients were 67.1% male, 94.4% Black, and 8.5% Hispanic. Average CHA2DS2VASc score was 0.92 (SD 1.1) and 63.4% were on ART. Cumulative incidence of NVAF at one and five years after HIV diagnosis were 0.48% (95% CI 0.36-0.63) and 2.16% (95% CI 1.85-2.51), respectively. HIV-related factors associated with incident NVAF included baseline CD4 count <200 (HR 1.84, 95% CI 1.20-2.80) and initial ART including protease inhibitors (HR 1.56, 95% CI 1.14-2.13) and/or integrase strand transfer inhibitors (HR 1.47, 95% CI 1.08-1.99). Additional associated factors included older age, Medicare, cardiology visit(s) in prior year, and co-morbid diseases including hypertension, hyperlipidemia, coronary and peripheral artery disease, prior stroke/transient ischemic attack, heart failure, and chronic kidney disease. Conclusions: In a large cohort of UREG living with HIV, both traditional and HIV-specific risk factors are associated with increased risk of incident NVAF. Interventions to mitigate NVAF risk in this population will require interdisciplinary, team-based approaches.
Kobe, Elizabeth
( Duke University Medical Center
, Durham
, North Carolina
, United States
)
Thomas, Kevin
( Duke University Medical Center
, Durham
, North Carolina
, United States
)
Bloomfield, Gerald
( Duke University Medical Center
, Durham
, North Carolina
, United States
)
Shah, Nishant
( Duke University Medical Center
, Durham
, North Carolina
, United States
)
Clare, Robert
( Duke Clinical Research Institute
, Durham
, North Carolina
, United States
)
Chiswell, Karen
( Duke Clinical Research Institute
, Durham
, North Carolina
, United States
)
Longenecker, Chris
( University of Washington
, Seattle
, Washington
, United States
)
Marsolo, Keith
( Duke Clinical Research Institute
, Durham
, North Carolina
, United States
)
Meissner, Eric
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Okeke, Nwora
( Duke University Medical Center
, Durham
, North Carolina
, United States
)
Pettit, April
( Vanderbilt University Medical Center
, Nashville
, Tennessee
, United States
)
Sanders, Gretchen
( Duke Clinical Research Institute
, Durham
, North Carolina
, United States
)
Author Disclosures:
Elizabeth Kobe:DO NOT have relevant financial relationships
| Kevin Thomas:DO have relevant financial relationships
;
Consultant:Boston Scientific:Active (exists now)
; Consultant:Janssen:Past (completed)
; Consultant:Bristol Myers Squibb:Past (completed)
; Consultant:Biosense Webster:Active (exists now)
| Gerald Bloomfield:DO NOT have relevant financial relationships
| Nishant Shah:DO have relevant financial relationships
;
Consultant:Amgen:Active (exists now)
; Researcher:Janssen:Past (completed)
; Consultant:Esperion:Past (completed)
; Consultant:Merck:Active (exists now)
; Researcher:Novartis:Active (exists now)
; Consultant:Novartis:Active (exists now)
; Researcher:Amgen:Active (exists now)
| Robert Clare:No Answer
| Karen Chiswell:DO NOT have relevant financial relationships
| Chris Longenecker:DO have relevant financial relationships
;
Advisor:Theratechnologies:Past (completed)
| Keith Marsolo:DO have relevant financial relationships
;
Research Funding (PI or named investigator):Norvartis:Active (exists now)
; Research Funding (PI or named investigator):Genentech:Past (completed)
; Research Funding (PI or named investigator):Seqirus:Past (completed)
; Research Funding (PI or named investigator):BMS:Active (exists now)
; Research Funding (PI or named investigator):GSK:Past (completed)
; Research Funding (PI or named investigator):Boehringer Ingelheim:Active (exists now)
; Research Funding (PI or named investigator):Pfizer:Active (exists now)
; Research Funding (PI or named investigator):Eli Lilly:Active (exists now)
; Research Funding (PI or named investigator):Merck:Active (exists now)
| Eric Meissner:DO NOT have relevant financial relationships
| Nwora Okeke:No Answer
| April Pettit:DO NOT have relevant financial relationships
| Gretchen Sanders:DO NOT have relevant financial relationships