Abstract P263: Adjudication of Heart Failure (HF) in an Electronic Cohort of Human Immunodeficiency Virus-infected (HIV+) Persons
Background: Analyses of administrative data suggest that HIV+ persons have elevated risks for HF from HIV-related and traditional cardiovascular disease (CVD) risk factors. However, none of these studies adjudicated HF diagnoses, which is essential given poor agreement between administrative coding and physician adjudication. We sought to create a reproducible protocol for identifying and adjudicating HF in HIV+ persons and to compare characteristics between those with and without adjudicated HF.
Methods: We screened for and adjudicated HF diagnoses in a cohort of 5,052 HIV+ persons receiving care at an academic center. Screening for possible HF included any of the following: 1) HF diagnosis code, 2) B-type natriuretic peptide (BNP) >100 pg/mL, or 3) intravenous diuretic use. Two physicians then independently reviewed all records. Definite HF was adjudicated if all of the following were present: HF symptoms, physician diagnosis, HF medication use, and objective evidence of myocardial dysfunction. Demographics and clinical characteristics were compared for HIV+ patients with screened+/adjudicated+ HF, screened+/adjudicated- HF, and those who screened- for HF.
Results: There was >96% agreement in HF diagnoses between the two adjudicators (Kappa = 0.91). Race differed significantly across the three groups, with more black patients among those with adjudicated+ HF (Table 1). Patients with adjudicated+ HF were significantly more likely than patients who screened+/adjudicated- HF to have diabetes, hypertension, atrial arrhythmias, a diagnosis of myocardial infarction, and any smoking history (p<0.001 for all). Patients who screened+ for HF (whether adjudicated+ or -) tended to have more advanced HIV than those who screened- based on nadir CD4 T cell count and peak HIV viral load (Table 1).
Conclusions: There are significant clinical differences between HIV+ patients with and without adjudicated HF. These findings underscore the importance of adjudicating HF in future studies characterizing CVD for HIV+ persons.
Author Disclosures: A.B. Steverson: None. A.E. Pawlowski: None. D. Schneider: None. P. Nannapaneni: None. J.M. Sanders: None. C.J. Achenbach: None. S.J. Shah: None. D.M. Lloyd-Jones: None. M.J. Feinstein: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2017 by American Heart Association, Inc.