Assessment Shows Potential Need for More Preventive Cardiovascular Care in Patients with HIV

There is a statistically significant difference in the number of patients that meet statin criteria for primary prevention, and those that were prescribed it in a Federally Qualified Health Center (FQHC), according to student research presented at the ASHP (American Society of Health-System Pharmacists) 54th Midyear Clinical Meeting & Exhibition in Las Vegas, Nevada.

The objective of the study was to investigate whether or not primary preventive cardiovascular care differs among patients with and without HIV infection in a FQHC. Patients with HIV infection are at a higher risk of arteriosclerotic cardiovascular disease (ASCVD), although the exact reason is not understood.

Patients with and without HIV infection that had at least 4 appointments between 2016-2018, and were between the ages of 40 years and 79 years, were included in the study. A matching pool of patients without HIV infection was used in the control arm, and patients that had a cardiovascular event were excluded from the study.

A retrospective chart review was done to identify patients within each arm that qualified for low-dose ASA, statin, and/or smoking cessation counseling. In addition, the American College of Cardiology ASCVD risk calculator and US Preventive Services Task Force were used to identify patients that qualify for primary prevention with a statin and low-dose ASA.

Patients who qualified for statin therapy were assessed for whether it was initiated, and if the dose was at the correct intensity. Those that qualified for low-dose ASA therapy were assessed for whether it was initiated. In addition, the patients who were identified as smokers were assessed for whether they received smoking cessation counseling in the past year.

One hundred and fifty patients with HIV and 150 participants not infected with HIV were evaluated. To compare the continuous variables and proportions, student’s t-tests and the chi square were used. The 2 arms were statistically compared to identify if a significant difference existed in the level of preventative cardiovascular (CV) care amongst patients with and without HIV infection.

The results of the study showed that 37 of the 150 patients with HIV met statin criteria, and 54.05% of those 37 patients were prescribed statin. Meanwhile, 105 of the 150 patients without HIV infection met statin criteria, with 89.52% of the 105 prescribed statin.

Only 12 of the 150 patients infected with HIV met ASA criteria, with 33% of those 12 prescribed ASA. In comparison, 16 of the 150 patients without HIV infection met ASA criteria and 50% of those 16 were prescribed ASA.

Fifty-seven of the patients with HIV were current smokers, and 82.46% of these patients received smoking cessation counseling in the past year. In patients without HIV infection, 17 were current smokers, with 76.47% of those patients receiving smoking cessation counseling in the past year.

The researchers shared that statistically significant difference in the results is likely due to limited time during HIV appointments to address preventive CV care compared to primary care appointments. In addition, although the sample size was an equal amount in both arms, there were limitations to analyze certain endpoints of the study due to a low sample size.

REFERENCE

Shaltout N, Basu S, Ozdener AE. Assessment of primary preventive cardiovascular care in patients with HIV infection in a FQHC. Poster presented at: ASHP 54th Midyear Clinical Meeting & Exhibition; Las Vegas, NV: December 9, 2019. Accessed December 16, 2019.