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Improvements over time in short-term mortality following myocardial infarction in the D: A: D Study

Hatleberg, CI; Ryom, L; El-Sadr, W; Smith, C; Weber, R; Reiss, P; Fontas, E; ... D:A:D Study Group, .; + view all (2016) Improvements over time in short-term mortality following myocardial infarction in the D: A: D Study. AIDS , 30 (10) pp. 1583-1596. 10.1097/QAD.0000000000001076. Green open access

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Abstract

OBJECTIVE: Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen. DESIGN: Prospective cohort study. METHODS: Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarised at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. RESULTS: 1008 HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI (odds ratio changed from 0.88 [95% confidence interval 0.83, 0.93] to 0.97 [0.91, 1.02]). CONCLUSIONS: Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.

Type: Article
Title: Improvements over time in short-term mortality following myocardial infarction in the D: A: D Study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000001076
Publisher version: http://journals.lww.com/aidsonline/Abstract/2016/0...
Language: English
Additional information: This is a non-final version of an article published in final form in: Hatleberg, CI; Ryom, L; El-Sadr, W; Smith, C; Weber, R; Reiss, P; Fontas, E; (2016) Improvements over time in short-term mortality following myocardial infarction in the D: A: D Study. AIDS, 30 (10) pp. 1583-1596. 10.1097/QAD.0000000000001076.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1476572
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