The Risk for Sudden Cardiac Death Among Patients Living With Heart Failure and Human Immunodeficiency Virus

Alvi, Raza M.; Neilan, Anne M.; Tariq, Noor; Hassan, Mahad M.; Awadalla, Magid; Zhang, Lili; Afshar, Maryam; Rokicki, Adam; Mulligan, Connor P.; Triant, Virginia A.; Zanni, Markella V.; Neilan, Tomas G.

doi:10.1016/j.jchf.2019.04.025

Cited by 28 publications

(34 citation statements)

References 25 publications

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“…This finding was further corroborated by Alvi et al 3 in 2019 in a retrospective study of 344 HIV‐infected individuals hospitalized with heart failure as compared to 1805 uninfected controls hospitalized with heart failure at the same Medical Center. In this study, HIV‐infected patients had a 3‐fold increased risk of SCD compared to the uninfected controls (21% vs 6.4%, p < .001) 3 . After adjustment for various confounders, coronary artery disease, cocaine use, no use of beta blockers, low CD4 count/unsuppressed viral load, low left ventricular ejection fraction, increased QTc duration, and wider QRS were all independently associated with SCD among the HIV‐infected patients 3 .…”

Section: Introductionsupporting

confidence: 63%

“…In this study, HIV‐infected patients had a 3‐fold increased risk of SCD compared to the uninfected controls (21% vs 6.4%, p < .001) 3 . After adjustment for various confounders, coronary artery disease, cocaine use, no use of beta blockers, low CD4 count/unsuppressed viral load, low left ventricular ejection fraction, increased QTc duration, and wider QRS were all independently associated with SCD among the HIV‐infected patients 3 . The mechanisms underlying this increased risk of sudden cardiac death among the HIV‐infected population are not clearly understood but are likely multifactorial including ventricular arrhythmias due to chronic inflammation/myocardial fibrosis, increased rate of traditional cardiovascular risk factors, increased illicit drug use, side effects of antiretroviral therapy, prolonged QT interval, and accelerated atherosclerosis (Figure 1).…”

Section: Introductionmentioning

confidence: 53%

“…HIV‐infected individuals have also been found to have up to a 4.5‐fold increased risk of sudden cardiac death (SCD) compared to uninfected individuals 2 . This finding was further corroborated by Alvi et al 3 in 2019 in a retrospective study of 344 HIV‐infected individuals hospitalized with heart failure as compared to 1805 uninfected controls hospitalized with heart failure at the same Medical Center. In this study, HIV‐infected patients had a 3‐fold increased risk of SCD compared to the uninfected controls (21% vs 6.4%, p < .001) 3 .…”

Section: Introductionmentioning

confidence: 65%

“…Increased prevalence of cardiomyopathy and heart failure has been noted in HIV‐infected individuals who die from sudden cardiac death as compared to AIDS and natural deaths combined 2 . Alvi et al 3 found that the SCD rate was higher in HIV‐infected individuals hospitalized with heart failure compared to uninfected controls hospitalized with heart failure within all three of the LVEF strata that were investigated (<35%, 35–49%, >50%).…”

Section: Structural Heart Disease/accelerated Atherosclerosismentioning

confidence: 99%

“…The use of illicit drugs such as cocaine and amphetamines has been found to be significantly more common in HIV‐infected individuals than in the uninfected population 3,27 . It is well‐known that cocaine and/or amphetamines can lead to abrupt sympathetic surges, myocardial infarctions, and development of nonischemic cardiomyopathy, all of which can lead to increased risk of ventricular tachycardia and ventricular fibrillation.…”

Section: Substance Abusementioning

confidence: 99%

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Sudden cardiac death in HIV‐infected patients: A contemporary review

Narla

2021

Clinical Cardiology

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HIV‐infected individuals have an increased risk of sudden cardiac death compared to the general population; yet the mechanisms underlying this increased risk remain unclear. The mechanisms underlying the heightened sudden cardiac death risk in HIV‐infected individuals is likely multifactorial. We reviewed the literature to elucidate and summarize the potential mechanisms contributing to sudden cardiac death in the HIV patient population. There is biologic plausibility that the following mechanisms may be contributing to the significantly heightened risk of sudden cardiac death in HIV to varying degrees: ventricular arrhythmias, myocardial fibrosis and scar, prolonged QTc interval (both as a direct effect of HIV on repolarization as well as a result of concurrent medications/antiretroviral therapies), substance abuse, structural heart disease, and premature atherosclerosis. Further understanding of the mechanisms underlying the increased sudden cardiac death risk in HIV can lead to identification of modifiable risk factors, implementation of public health programs, and potential revision of ICD implantation guidelines to ultimately reduce the incidence of sudden cardiac death in HIV‐infected patients. Further studies are needed to assess the relative contribution of each of these mechanisms and risk factors.

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Section: Introductionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 65%

Section: Structural Heart Disease/accelerated Atherosclerosismentioning

confidence: 99%

Section: Substance Abusementioning

confidence: 99%

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Sudden cardiac death in HIV‐infected patients: A contemporary review

Narla

2021

Clinical Cardiology

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Outcomes of implantable cardioverter‐defibrillator implantation in HIV‐infected patients: A single‐center retrospective cohort study

Narla

Yang

2022

Clinical Cardiology

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Background HIV‐infected individuals have a known increased risk of sudden cardiac death (SCD) compared to uninfected individuals. Implantable cardioverter‐defibrillators (ICDs) are standard therapy for preventing SCD; however, there is limited data on the outcomes of ICDs in HIV‐infected individuals. Hypothesis HIV‐infected subjects receive a higher number of appropriate ICD therapies than uninfected controls. Methods This is a retrospective cohort study of 35 consecutive HIV‐Infected patients and 36 uninfected controls matched by age, race, and gender who were treated at the University of North Carolina Medical Center in the outpatient or inpatient setting from 2014 to the present and had undergone ICD implantation. For HIV‐infected subjects, a multivariate Poisson regression analysis was performed to evaluate the association between covariates and ICD therapies. Results Among HIV‐infected subjects, the mean CD4 count was 582.5 cells/mm3 and 69% had an undetectable viral load. The median follow‐up was 6.4 years. HIV‐infected subjects had both a higher number of appropriate ICD shocks or antitachycardia pacing (ATP) therapy per person‐year as well as a higher number of inappropriate ICD shocks per person‐year than uninfected controls (1.512 vs. 0.590 and 0.122 vs. 0.0166, respectively, p < .001 for both comparisons). After multivariate adjustment, the presence of detectable/unsuppressed viral load at the time of ICD implantation was an independent predictor of both of the following in HIV‐infected subjects: (1) appropriate ICD discharge (p = .004), and (2) appropriate ICD discharge or appropriate ATP therapy (p < .001). Conclusion HIV‐infected subjects had a higher number of appropriate ICD discharge or ATP therapy per person‐year than matched uninfected controls.

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Infection and arterial stiffness

Corrales–Medina

Chirinos

2022

Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease

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The Risk for Sudden Cardiac Death Among Patients Living With Heart Failure and Human Immunodeficiency Virus

Cited by 28 publications

References 25 publications

Sudden cardiac death in HIV‐infected patients: A contemporary review

Sudden cardiac death in HIV‐infected patients: A contemporary review

Outcomes of implantable cardioverter‐defibrillator implantation in HIV‐infected patients: A single‐center retrospective cohort study

Infection and arterial stiffness

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