HIV impacts outcomes of patients admitted for STEMI and NSTEMI

Background Human Immunodeficiency Virus (HIV) mortality rates are falling globally; currently at 11 deaths per 100,000 population, forecasted to decrease to 8.5 deaths by 2040. Concurrently, HIV continues to predispose an individual to an immunocompromised state and is a major risk factor on mortality of patients with cardiovascular diseases (CVD). Current trends on patient outcomes for people with HIV (PWH) and CVD is limited. In this analysis, authors aim to investigate the impact of HIV in patients admitted due to STEMI and NSTEMI. Authors hypothesize that HIV would have a negative impact on the in-hospital outcomes. Methods In this United States National Inpatient Sample Database analysis during the years 2016-2020, patients admitted with a primary diagnosis of STEMI and NSTEMI, with or without a secondary diagnosis of HIV were identified using ICD-10 codes. The primary outcome was all-cause, inpatient mortality. Secondary outcomes were length of stay, and resources utilization. Univariate and multivariate analysis was performed using STATA, adjusting for patient and hospital variables. Data was considered statistically significant with p-value <0.05. Results Out of 851,320 STEMI patients, 4,125 had HIV, and out of 2,242,159 NSTEMI patients, 9,285 had HIV. PWH and STEMI had a mean age of 56 years, and those with NSTEMI had a mean age of 58 years, compared to 64 and 68 years for non-HIV patients, respectively. PWH and STEMI had 44% lower odds of death (OR 0.56, p=0.001, 95% CI: 0.39-0.79), and PWH with NSTEMI had 33% lower odds (OR 0.67, p=0.029, 95% CI: 0.47-0.96) when compared with patients without HIV. PWH and STEMI stayed 2 days fewer in the hospital (coefficient -2.1, p<0.001, 95% CI: -2.57 to -1.64), and those with NSTEMI stayed 1.63 days fewer (coefficient -1.63, p<0.001, 95% CI: -1.93 to -1.33). PWH and STEMI spent $24,552.84 less (coefficient -$25,552.84, p<0.001, 95% CI: -$37,634.30 to -$11,471.37), and those with NSTEMI spent $13,029.75 less (coefficient -$13,029.75, p=0.023, 95% CI: -$24,231.35 to -$1,828.15). However, PWH with both conditions were more likely to require intubation (STEMI: coefficient 0.56, p<0.001, 95% CI: 0.41-0.77; NSTEMI: coefficient 0.52, p<0.001, 95% CI: 0.38-0.72). Conclusion Contrary to our hypothesis, PWH who were admitted for STEMI and NSTEMI showed a mortality benefit with a shorter hospital stay; however, PWH were more frequently intubated. Advances in ART and a younger patient cohort may account for some of these differences. Prospective studies are needed to elucidate these findings with careful interpretation of results as PWH remains a vulnerable population.