Heart failure among people with HIV: prescription of guideline-directed medical therapy

BACKGROUND: People with HIV have an increased risk of heart failure (HF) compared to people without HIV. Guideline-directed medical therapy (GDMT) is the cornerstone of HF management, but little is known about GDMT prescription in this high-risk population. OBJECTIVE: To evaluate GDMT intensity and identify patient factors associated with optimal HF therapy among people with HIV and systolic HF. METHODS: We conducted retrospective analyses of the PATHWAYS study, a multi-institutional study of underrepresented racial and ethnic minorities with HIV. Adult patients with systolic HF (by ICD code) were included. A composite GDMT score was constructed using dosage-weighted prescription of GDMT drugs, ranging from 0% to 100% (with 100% indicating optimal therapy). RESULTS: Among 451 PWH with systolic HF, the median age was 54 years (IQR = 47-62), 34.6% were female, and 96.6% were Black. In the year after HF diagnosis, 85.8% of patients were prescribed any GDMT, and 45.5% of patients attended a cardiology clinic visit. The mean GDMT score was 30% (SD = 22%). In multivariable analyses, lower GDMT scores occurred among patients with older age (adjusted mean ratio [AMR] = 0.96, 95% CI: 0.93-0.99) and severe renal disease (AMR = 0.84, 95% CI: 0.71-0.99). Higher GDMT scores occurred among patients with diabetes mellitus (AMR = 1.33, 95% CI: 1.16-1.53), prior myocardial infarction (AMR = 1.17, 95% CI: 1.02-1.35), and those who attended a cardiology clinic visit (AMR = 1.29, 95% CI: 1.13-1.47). CONCLUSIONS: People with HIV and HF had low GDMT scores, suggesting suboptimal intensity of HF care. Cardiology clinic attendance was associated with higher GDMT scores.