Sudden cardiac death in patients with human immunodeficiency virus infection

Zian H. Tseng, Eric A. Secemsky, David Wesley Dowdy, Eric Vittinghoff, Brian Moyers, Joseph K. Wong, Diane V. Havlir, Priscilla Y. Hsue

Research output: Contribution to journalArticle

Abstract

Objectives: The aim of this study was to determine the incidence and clinical characteristics of sudden cardiac death (SCD) in patients with human immunodeficiency virus (HIV) infection. Background: As the HIV-infected population ages, cardiovascular disease prevalence and mortality are increasing, but the incidence and features of SCD have not yet been described. Methods: The records of 2,860 consecutive patients in a public HIV clinic in San Francisco between April 2000 and August 2009 were examined. Identification of deaths, causes of death, and clinical characteristics were obtained by search of the National Death Index and/or clinic records. SCDs were determined using published retrospective criteria: 1) the International Classification of Diseases-10th Revision, code for all cardiac causes of death; and (2) circumstances of death meeting World Health Organization criteria. Results: Of 230 deaths over a median of 3.7 years of follow-up, 30 (13%) met SCD criteria, 131 (57%) were due to acquired immune deficiency syndrome (AIDS), 25 (11%) were due to other (natural) diseases, and 44 (19%) were due to overdoses, suicides, or unknown causes. SCDs accounted for 86% of all cardiac deaths (30 of 35). The mean SCD rate was 2.6 per 1,000 person-years (95% confidence interval: 1.8 to 3.8), 4.5-fold higher than expected. SCDs occurred in older patients than did AIDS deaths (mean 49.0 vs. 44.9 years, p = 0.02). Compared with AIDS and natural deaths combined, SCDs had a higher prevalence of prior myocardial infarction (17% vs. 1%, p <0.0005), cardiomyopathy (23% vs. 3%, p <0.0005), heart failure (30% vs. 9%, p = 0.004), and arrhythmias (20% vs. 3%, p = 0.003). Conclusions: SCDs account for most cardiac and many non-AIDS natural deaths in HIV-infected patients. Further investigation is needed to ascertain underlying mechanisms, which may include inflammation, antiretroviral therapy interruption, and concomitant medications.

Original languageEnglish (US)
Pages (from-to)1891-1896
Number of pages6
JournalJournal of the American College of Cardiology
Volume59
Issue number21
DOIs
StatePublished - May 22 2012

Fingerprint

Sudden Cardiac Death
Virus Diseases
HIV
Acquired Immunodeficiency Syndrome
Cause of Death
San Francisco
Mortality
Incidence
International Classification of Diseases
Cardiomyopathies
Suicide
Cardiac Arrhythmias
Cardiovascular Diseases
Heart Failure
Myocardial Infarction
Confidence Intervals
Inflammation

Keywords

  • AIDS
  • arrhythmia
  • death
  • sudden

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Tseng, Z. H., Secemsky, E. A., Dowdy, D. W., Vittinghoff, E., Moyers, B., Wong, J. K., ... Hsue, P. Y. (2012). Sudden cardiac death in patients with human immunodeficiency virus infection. Journal of the American College of Cardiology, 59(21), 1891-1896. https://doi.org/10.1016/j.jacc.2012.02.024

Sudden cardiac death in patients with human immunodeficiency virus infection. / Tseng, Zian H.; Secemsky, Eric A.; Dowdy, David Wesley; Vittinghoff, Eric; Moyers, Brian; Wong, Joseph K.; Havlir, Diane V.; Hsue, Priscilla Y.

In: Journal of the American College of Cardiology, Vol. 59, No. 21, 22.05.2012, p. 1891-1896.

Research output: Contribution to journalArticle

Tseng, ZH, Secemsky, EA, Dowdy, DW, Vittinghoff, E, Moyers, B, Wong, JK, Havlir, DV & Hsue, PY 2012, 'Sudden cardiac death in patients with human immunodeficiency virus infection', Journal of the American College of Cardiology, vol. 59, no. 21, pp. 1891-1896. https://doi.org/10.1016/j.jacc.2012.02.024
Tseng, Zian H. ; Secemsky, Eric A. ; Dowdy, David Wesley ; Vittinghoff, Eric ; Moyers, Brian ; Wong, Joseph K. ; Havlir, Diane V. ; Hsue, Priscilla Y. / Sudden cardiac death in patients with human immunodeficiency virus infection. In: Journal of the American College of Cardiology. 2012 ; Vol. 59, No. 21. pp. 1891-1896.
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abstract = "Objectives: The aim of this study was to determine the incidence and clinical characteristics of sudden cardiac death (SCD) in patients with human immunodeficiency virus (HIV) infection. Background: As the HIV-infected population ages, cardiovascular disease prevalence and mortality are increasing, but the incidence and features of SCD have not yet been described. Methods: The records of 2,860 consecutive patients in a public HIV clinic in San Francisco between April 2000 and August 2009 were examined. Identification of deaths, causes of death, and clinical characteristics were obtained by search of the National Death Index and/or clinic records. SCDs were determined using published retrospective criteria: 1) the International Classification of Diseases-10th Revision, code for all cardiac causes of death; and (2) circumstances of death meeting World Health Organization criteria. Results: Of 230 deaths over a median of 3.7 years of follow-up, 30 (13{\%}) met SCD criteria, 131 (57{\%}) were due to acquired immune deficiency syndrome (AIDS), 25 (11{\%}) were due to other (natural) diseases, and 44 (19{\%}) were due to overdoses, suicides, or unknown causes. SCDs accounted for 86{\%} of all cardiac deaths (30 of 35). The mean SCD rate was 2.6 per 1,000 person-years (95{\%} confidence interval: 1.8 to 3.8), 4.5-fold higher than expected. SCDs occurred in older patients than did AIDS deaths (mean 49.0 vs. 44.9 years, p = 0.02). Compared with AIDS and natural deaths combined, SCDs had a higher prevalence of prior myocardial infarction (17{\%} vs. 1{\%}, p <0.0005), cardiomyopathy (23{\%} vs. 3{\%}, p <0.0005), heart failure (30{\%} vs. 9{\%}, p = 0.004), and arrhythmias (20{\%} vs. 3{\%}, p = 0.003). Conclusions: SCDs account for most cardiac and many non-AIDS natural deaths in HIV-infected patients. Further investigation is needed to ascertain underlying mechanisms, which may include inflammation, antiretroviral therapy interruption, and concomitant medications.",
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