Mortality and health service use following acute myocardial infarction among persons with HIV: a population-based study

Background — People with HIV have higher rates of acute myocardial infarction (AMI) than HIV-negative individuals. We compared mortality risk and health service use following AMI among people with and without HIV between January 1, 2002 and March 31, 2015.

Methods — We conducted a population-based study using Ontario's administrative databases. Our primary outcomes were risk of inpatient death and death at 30 days following hospital discharge. In secondary analyses, we compared use of revascularization procedures within 90 days of AMI, as well as readmission or emergency department visits for heart disease and cardiology follow-up within 90 days of discharge.

Results — We studied 259,475 AMI patients, of whom 345 (0.13%) were people with HIV. AMI patients with HIV were younger than HIV-negative patients [mean age + standard deviation: 54.4 + 10.5 versus 69.3 + 14.3 years). Following multivariable adjustment, the odds ratios for inpatient death and death at 30 days following discharge were 1.04 [95% confidence intervals (CI): 0.64 to 1.56] and 2.42 (95% CI 1.00 to 4.92], respectively. In secondary analyses, no differences were observed in receipt of revascularization procedures [hazard ratio (HR) 0.98; 95% CI 0.85 to 1.12], readmission or emergency department visit for heart disease (HR 1.18; 95% CI 0.85 to 1.62) or cardiology follow-up (HR 0.88; 95% CI 0.76 to 1.01).

Conclusions — People with HIV experience AMI at younger ages and may be at higher risk of death in the 30 days following hospital discharge, underscoring the importance of targeting modifiable cardiovascular disease risk factors in these patients.