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American Heart Association

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Final ID: MDP1046

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
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Breaking Barriers: Addressing Disparities in Cardiovascular Health and Training

Sunday, 11/17/2024 , 03:15PM - 04:30PM

Moderated Digital Poster Session

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