CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

814

Physician-Confirmed Incident Heart Failure Phenotypes and Etiologies Within CNICS Nour Beydoun 1 , Robin M. Nance 2 , Alexander P. Hoffmann 2 , Matthew S. Durstenfeld 3 , Bridget M. Whitney 2 , Greer Burkholder 4 , Priscilla Hsue 5 , Joseph A. Delaney 2 , Chris Longenecker 2 , Heidi M. Crane 2 , Matthew J. Feinstein 1 1 Northwestern University, Chicago, IL, USA, 2 University of Washington, Seattle, WA, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 University of Alabama at Birmingham, Birmingham, AL, USA, 5 University of California Los Angeles, Los Angeles, CA, USA Background: People with HIV (PWH) have elevated risk for heart failure (HF). However, limited multi-center data exist on presentations and etiologies of HIV-associated HF. Methods: We adjudicated incident HF events occurring between January 1, 2010 and December 31, 2023 at University of Washington (UW) and University of Alabama-Birmingham (UAB), which are two centers within the CFAR Network of Integrated Clinical Systems (CNICS). PWH in CNICS with possible HF were first identified by a screening protocol incorporating administrative codes and biomarkers of cardiac congestion. Individuals with HF prior to baseline were excluded. Two independent physician adjudicators reviewed clinical records to adjudicate events, with confirmed HF diagnosis requiring a combination of symptoms, physician diagnosis, and HF medication use. Adjudicators also determined: (1) HF subtypes (by left ventricular ejection fraction, LVEF) based on echocardiography closest in time to HF onset, and (2) presumed etiologies (e.g., ischemic and/or non-ischemic) based on review of physician notes, procedure notes, and comorbidities present at HF onset. Using Cox proportional hazard regression, hazard ratios and 95% CIs were used to examine associations of risk factors with incident HF. Results: After excluding 50 PWH with confirmed HF at baseline, there were 212 PWH with incident adjuciated HF, of whom 106 (50%) had HF with reduced LVEF (HFrEF, LVEF<40%), 75 (35%) had HF with preserved LVEF (HFpEF, LVEF≥50%), 28 (13%) had HF with midrange LVEF (HFmrEF, LVEF ≥40% and <50%), and 3 (1%) had unknown LVEF classification. Regarding physician-determined HF etiology, 115 (54%) had nonischemic etiology, 36 (17%) had mixed ischemic and nonischemic etiology, 24 (11%) had ischemic etiology only, and 37 (17%) had unknown etiology. The most common nonischemic etiologies of HF were hypertensive and substance use, with hypertensive etiologies more common at UAB and substance use related etiologies more common at UW. Higher HIV viral load and lower CD4 count were associated with significantly higher incidence of adjudicated HF ( Table ) as were older age, smoking, hypertension, diabetes mellitus, history of myocardial infarction, and renal insufficiency. Conclusions: Nonischemic etiologies of HF are common among PWH. HIV viremia, low CD4 T cell count, traditional CVD risk factors, and renal insufficiency were associated with higher risk of incident HF. Efforts to define HIV-specific presentations and etiologies of HF are needed.

815

Readmission Risk for Adults With HIV Hospitalized for Heart Failure or Acute Myocardial Infarction Ping Yang 1 , Xianming Zhu 2 , Eshan U. Patel 2 , Wendy Post 2 , M. Kate Grabowski 3 , Thomas C. Quinn 2 , Stephen A. Berry 2 , Kelly Gebo 1 , Aaron A. R. Tobian 1 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 The Johns Hopkins University, Baltimore, MD, USA, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: People with HIV (PWH) have a higher incidence of cardiovascular disease, including heart failure (HF) and acute myocardial infarction (AMI) than people without HIV (PWoH). In the general population, 30-day readmissions following hospitalizations for HF and AMI are common, and reducing these readmissions is a national quality of care priority. This study compares the 30-day readmission risk between adult PWH and PWoH hospitalized for HF or AMI in the US. Methods: We conducted a retrospective cohort analysis using the 2021 Nationwide Readmissions Database. Using International Classification of Diseases, Tenth Revision, Clinical Modification codes, we identified adults admitted for HF or AMI. The primary outcome was 30-day all-cause unplanned readmission. We estimated age-adjusted risk ratios (aRR) of readmission by HIV status using random-effects logistic regressions with marginal estimates. Subgroup analyses were conducted stratified by age and sex. All analyses used survey weights to generate national estimates. Results: We included 1,055,524 (weighted) adult index (initial) hospitalizations for HF and 475,514 for AMI. In both HF and AMI populations, PWH were more likely than PWoH to be male (HF: 69% vs. 53%; AMI: 80% vs. 64%) and to reside in low-income areas (HF: 53% vs. 32%; AMI: 45% vs. 29%). Among HF index hospitalizations, PWH had a significantly higher readmission risk (32%) compared to PWoH (22%), (aRR=1.37; 95%CI=1.30-1.44). Similarly, for AMI hospitalizations, PWH had a significantly higher readmission risk (18%) than PWoH (12%), (aRR=1.67; 95%CI=1.47-1.88). For HF, the most common diagnostic categories for both PWH and PWoH readmissions were cardiovascular (57% vs. 55%), infectious (15% vs. 14%), and respiratory (7% vs. 6%). For AMI, the leading reasons for readmission among PWoH were cardiovascular (57%), infectious (13%), and digestive (7%), while in PWH, the top categories were cardiovascular (42%), infectious (15%), and both digestive and respiratory (6%). In age- and sex-stratified analysis, PWH consistently had higher readmission risks than PWoH for both HF and AMI, with the largest disparities observed in younger males and older females (Figure). Conclusions: For hospitalizations due to HF and AMI, PWH had significantly higher 30-day readmission risks than PWoH. Targeted interventions are needed to reduce readmission risks among PWH with HF and AMI, especially as the burden of these comorbid conditions grows. The figure, table, or graphic for this abstract has been removed. Long-Term Outcomes in People With HIV Who Survive a Major Adverse Cardiovascular Event Rebecka Papaioannu Borjesson 1 , Pierluigi Reali 1 , Riccardo Lolatto 1 , Caterina Candela 2 , Alessia Siribelli 2 , Tommaso Clemente 1 , Girolamo Piromalli 1 , Martina Ranzenigo 1 , Hamid Hasson 1 , Camilla Muccini 1 , Antonella Castagna 1 , Vincenzo Spagnuolo 1 1 IRCCS San Raffaele Scientific Institute, Milan, Italy, 2 San Raffaele Vita-Salute University, Milan, Italy Background: Major adverse cardiovascular events (MACEs) are now a leading cause of morbidity and mortality in people with HIV (PWH). Data on the long term outcomes of PWH who have survived a MACE are lacking. Our aim was to evaluate overall survival and its predictors in PWH who survived a MACE. Methods: Retrospective cohort study on PWH followed at IRCCS San Raffaele, Milan, who experienced at least one MACE between 1st/Jan/2008 and 31st/ Dec/2023. Follow-up (FU) accrued from the first MACE (baseline, BL) until death/last visit. To evaluate the outcomes of MACE survivors, we excluded from the analysis those who died within 30 days of baseline. MACEs included: myocardial infarction; hospitalization for unstable angina; stroke; transient ischemic attack; peripheral arterial ischemia; arterial revascularization; cardiovascular death. Survival curves estimated using Kaplan–Meyer method. Univariate Cox regressions and Mantel-Haenszel method estimated the mortality hazard ratio (HR) and 95% Confidence Interval (95%CI) of continuous and nominal variables,

Poster Abstracts

816

CROI 2025 245