Disparities in the Quality of Cardiovascular Care Between HIV-Infected Versus HIV-Uninfected Adults in the United States: A Cross-Sectional Study

Abstract

Background: Cardiovascular disease is emerging as a major cause of morbidity and mortality among patients with HIV. We compared use of national guideline-recommended cardiovascular care during office visits among HIV-infected versus HIV-uninfected adults.

Methods and results: We analyzed data from a nationally representative sample of HIV-infected and HIV-uninfected patients aged 40 to 79 years in the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey, 2006 to 2013. The outcome was provision of guideline-recommended cardiovascular care. Logistic regressions with propensity score weighting adjusted for clinical and demographic factors. We identified 1631 visits by HIV-infected patients and 226 862 visits by HIV-uninfected patients with cardiovascular risk factors, representing ≈2.2 million and 602 million visits per year in the United States, respectively. The proportion of visits by HIV-infected versus HIV-uninfected adults with aspirin/antiplatelet therapy when patients met guideline-recommended criteria for primary prevention or had cardiovascular disease was 5.1% versus 13.8% (P=0.03); the proportion of visits with statin therapy when patients had diabetes mellitus, cardiovascular disease, or dyslipidemia was 23.6% versus 35.8% (P<0.01). There were no differences in antihypertensive medication therapy (53.4% versus 58.6%), diet/exercise counseling (14.9% versus 16.9%), or smoking cessation advice/pharmacotherapy (18.8% versus 22.4%) between HIV-infected versus HIV-uninfected patients, respectively.

Conclusions: Physicians generally underused guideline-recommended cardiovascular care and were less likely to prescribe aspirin and statins to HIV-infected patients at increased risk-findings that may partially explain higher rates of adverse cardiovascular events among patients with HIV. US policymakers and professional societies should focus on improving the quality of cardiovascular care that HIV-infected patients receive.

Keywords: HIV; cardiovascular disease; medical care; quality of care.

Figure 1

Unadjusted trends in medication use among HIV‐infected and HIV‐uninfected patients with cardiovascular risk factors seeing physicians in US Ambulatory Care Visits, 2006 to 2013. In some years, data in HIV‐infected patients did not meet statistical reliability standards because of small sample sizes, and estimates for these years may be inaccurate (2006–2007, 2008–2009, and 2012–2013 for aspirin/antiplatelet therapy; 2012–2013 for statin therapy; 2012–2013 for antihypertensive therapy). CV indicates cardiovascular.

Figure 2

Trends in behavioral therapy among HIV‐infected and HIV‐uninfected patients with cardiovascular risk factors seeing physicians in US Ambulatory Care Visits, 2006 to 2013. In some years, data in HIV‐infected patients did not meet statistical reliability standards because of small sample sizes, and estimates for these years may be inaccurate (2006–2007, 2008–2009, and 2012–2013 for diet/exercise counseling; and 2012–2013 for smoking cessation advice). CV indicates cardiovascular.