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Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?

Okeke NL, Schafer KR, Meissner EG, Ostermann J, Shah AD, Ostasiewski B, Phelps E, Kieler CA, Oladele E, Garg K, Naggie S, Bloomfield GS, Bosworth HB. Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?. Open forum infectious diseases. 2020 Sep 1; 7(9):ofaa361.

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Abstract:

Background: The impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear. Methods: PWH receiving care at 3 Southeastern US academic HIV clinics between January 2014 and December 2016 were retrospectively stratified into 5 groups based on the specialty of the clinician managing their hypertension or hyperlipidemia. Patients were followed until first atherosclerotic cardiovascular disease event, death, or end of study. Outcomes of interest were meeting 8th Joint National Commission (JNC-8) blood pressure (BP) goals and National Lipid Association (NLA) non-high-density lipoprotein (HDL) goals for hypertension and hyperlipidemia, respectively. Point estimates for associated risk factors were generated using modified Poisson regression with robust error variance. Results: Of 1667 PWH in the analysis, 965 had hypertension, 205 had hyperlipidemia, and 497 had both diagnoses. At study start, the median patient age was 52 years, 66% were Black, and 65% identified as male. Among persons with hypertension, 24% were managed by an infectious diseases (ID) clinician alone, and 5% were co-managed by an ID clinician and a primary care clinician (PCC). Persons managed by an ID clinician were less likely to meet JNC-8 hypertension targets at the end of observation than the rest of the cohort (relative risk [RR], 0.84; 95% CI, 0.75-0.95), but when mean study blood pressure was considered, there was no difference between persons managed by ID and the rest of the cohort (RR, 0.96; 95% CI, 0.88-1.05). There was no significant association between the ID clinician managing hyperlipidemia and meeting NLA non-HDL goals (RR, 0.89; 95% CI, 0.68-1.15). Conclusions: Clinician specialty may play a role in suboptimal hypertension outcomes in persons with HIV.





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