HIV impacts in-hospital mortality, resource utilization, and need for intubation in patients admitted due to heart failure exacerbation

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Abstract Background Human immunodeficiency virus (HIV) is a significant public health issue worldwide. As of the end of 2023, 77% of all people living with HIV were accessing antiretroviral therapy (ART) globally. Mortality rates show a steady decrease due to patients being diagnosed with HIV early, with an availability ART and viral load suppression with ART. However, HIV predisposes an individual to an immunocompromised state and it is a major risk factor on mortality of patients with cardiovascular diseases (CVD) like heart failure (HF). Updated literature is limited on in-patient outcomes for patients with HIV and CVD. In this analysis, authors aim to investigate the impact of HIV in patients admitted due to HF. Authors hypothesize that HIV would have a negative impact on in-hospital outcomes. Methods This is an analysis of the United States National Inpatient Sample Database of the years 2016-2020. Patients admitted with a primary diagnosis of HF, with or without a secondary diagnosis of HIV were identified using the ICD-CM codes. The primary outcome was mortality. Secondary outcomes were length of stay, and resources utilization during admission. Univariate analysis was done on patient and hospital baseline characteristics. Variables with p<0.2 were considered for adjustment on a subsequent multivariate analysis. Data was considered statistically significant with p-value <0.05. Results Out of 1,187,164 patients with HF, 6460 had HIV. PWH had a mean age of 54 years old and patients without HIV had a mean age of 71 years old. PWH and HF had a 49% decrease in odds of all-cause in-patient mortality compared to patients without HIV (OR 0.51, p value 0.024, 95% CI: 0.29 - 0.92). PWH stayed 1.37 days less in the hospital (coefficient -1.37, p value < 0.001, 95% CI -1.73 to -1.01). In terms of total hospital charges, PWH did not significantly spend more or less money compared with patients without HIV (Coefficient -11208.12, p=0.088, 95% CI -$24101.33 to $1685.101). However, PWH and HF needed to be intubated more than those without HIV, with a regression coefficient of 0.61 (Coefficient 0.61, p=0.045, 95% CI 0.38 - 0.99). Conclusion Contrary to our hypothesis, PWH who were admitted for HF showed a mortality benefit of 49 % and had a 1.37 days shorter hospital stay; however, PWH and STEMI were more frequently intubated, with a regression coefficient of 0.61. Advances in ART and a younger patient cohort may account for some of these differences; however, prospective studies are needed to elucidate these findings with careful interpretation of results in this vulnerable population.

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