Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals
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Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals. / Hatleberg, Camilla Ingrid; Nielsen, Lene Ryom; El-Sadr, Wafaa; Smith, Colette; Weber, Rainer; Reiss, Peter; Fontas, Eric; Dabis, Francois; Law, Matthew; Monforte, Antonella d'Arminio; De Wit, Stephane; Mocroft, Amanda; Phillips, Andrew; Lundgren, Jens D; Sabin, Caroline; D:A:D Study Group.
In: AIDS (London, England), Vol. 30, No. 10, 19.06.2016, p. 1583-1596.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals
AU - Hatleberg, Camilla Ingrid
AU - Nielsen, Lene Ryom
AU - El-Sadr, Wafaa
AU - Smith, Colette
AU - Weber, Rainer
AU - Reiss, Peter
AU - Fontas, Eric
AU - Dabis, Francois
AU - Law, Matthew
AU - Monforte, Antonella d'Arminio
AU - De Wit, Stephane
AU - Mocroft, Amanda
AU - Phillips, Andrew
AU - Lundgren, Jens D
AU - Sabin, Caroline
AU - D:A:D Study Group
PY - 2016/6/19
Y1 - 2016/6/19
N2 - OBJECTIVE: Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen.DESIGN: Prospective cohort study.METHODS: Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI.RESULTS: One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)].CONCLUSION: Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.
AB - OBJECTIVE: Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen.DESIGN: Prospective cohort study.METHODS: Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI.RESULTS: One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)].CONCLUSION: Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.
U2 - 10.1097/QAD.0000000000001076
DO - 10.1097/QAD.0000000000001076
M3 - Journal article
C2 - 26950315
VL - 30
SP - 1583
EP - 1596
JO - AIDS
JF - AIDS
SN - 1350-2840
IS - 10
ER -
ID: 169567456