Patients with HIV and coronary disease: are we meeting national guidelines?
Sam Emmanuel A , James Nadel A B , Damien Fagan C , Sirinya Teeraananchai D , Matthew Law D and Cameron J. Holloway A E F GA St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
B University of Notre Dame, 160 Oxford Street, Darlinghurst, NSW 2010, Australia.
C Gilead Sciences, 417 St Kilda Road, Melbourne, Vic. 3004, Australia.
D Kirby Institute, University of New South Wales, High Street, Kensington, NSW 2052, Australia.
E St Vincent’s Clinical School, University of New South Wales, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
F Victor Chang Cardiac Research Institute, 405 Liverpool Street, Darlinghurst, NSW 2010, Australia.
G Corresponding author. Email: cholloway@svha.org.au
Sexual Health 15(1) 83-85 https://doi.org/10.1071/SH17035
Submitted: 21 February 2017 Accepted: 22 May 2017 Published: 20 July 2017
Abstract
Cardiovascular disease (CVD) has a higher incidence in patients with HIV infection. This study sought to determine whether HIV-infected patients with established CVD were being managed according to national guidelines. Data were collected from Australian general practitioners for 77 HIV-infected patients with a median age of 59 (range 54–64). There was good adherence to guidelines with regards to anti-platelet (84%; n = 65; 95% confidence interval (CI) 74–92%) and statin therapy (97%; n = 75; 95% CI 91–100%), despite a failure to meet cholesterol targets, with only 31% (n = 24; 95% CI 21–42%) of the cohort meeting low-density lipoprotein target values. Similarly, there was limited adherence to guidelines regarding the prescriptions of medications for those with established hypertension (66%; n = 51; 95% CI 55–77%), body mass index targets met (40%; n = 31; 95% CI 29–52%), and depression screening (32%; n = 25; 95% CI 22–44%). This Australian audit provides insight into adherence to guidelines for individuals with CVD and HIV, suggesting that current screening and management practices for these patients falls short of guidelines, particularly in relation to cholesterol management.
References
[1] Australian Institute of Health and Welfare. Deaths from cardiovascular disease. 2016. Available online at: http://www.aihw.gov.au/cardiovascular-disease/deaths/ [verified 21 August 2016].[2] Australian Institute of Health and Welfare. Health care expenditure on cardiovascular diseases 2004–05. 2008. Available online at: http://www.aihw.gov.au/publication-detail/?id=60129546381 [verified 21 August 2016].
[3] Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, Mitch W, Smith SC, Sowers JR. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999; 100 1134–46.
| Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1Mvgs1KjsA%3D%3D&md5=1e752ecec5f21919c27645dec97adab1CAS |
[4] Friis-Møller N, Weber R, Reiss P, Thiébaut R, Kirk O, d’Arminio Monforte A, Pradier C, Morfeldt L, Mateu S, Law M, El-Sadr W, De Wit S, Sabin CA, Phillips AN, Lundgren JD, DAD study group Cardiovascular disease risk factors in HIV patients – association with antiretroviral therapy. Results from the DAD study. AIDS 2003; 17 1179–93.
| Cardiovascular disease risk factors in HIV patients – association with antiretroviral therapy. Results from the DAD study.Crossref | GoogleScholarGoogle Scholar |
[5] National Heart Foundation of Australia (NHF) and Cardiac Society of Australia and New Zealand (CSANZ). Reducing risk in heart disease: an expert guide to clinical practice for secondary prevention of coronary heart disease. Melbourne: NHF and CSANZ; 2012.
[6] Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med 2005; 352 48–62.
| Cardiovascular risk and body-fat abnormalities in HIV-infected adults.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXis12muw%3D%3D&md5=bf5348bc92a660d79026ae1ab2e4ff26CAS |
