Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?

dc.contributor.author

Okeke, Nwora Lance

dc.contributor.author

Schafer, Katherine R

dc.contributor.author

Meissner, Eric G

dc.contributor.author

Ostermann, Jan

dc.contributor.author

Shah, Ansal D

dc.contributor.author

Ostasiewski, Brian

dc.contributor.author

Phelps, Evan

dc.contributor.author

Kieler, Curtis A

dc.contributor.author

Oladele, Eniola

dc.contributor.author

Garg, Keva

dc.contributor.author

Naggie, Susanna

dc.contributor.author

Bloomfield, Gerald S

dc.contributor.author

Bosworth, Hayden B

dc.date.accessioned

2023-03-02T15:08:12Z

dc.date.available

2023-03-02T15:08:12Z

dc.date.issued

2020-09

dc.date.updated

2023-03-02T15:08:11Z

dc.description.abstract

Background

The impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear.

Methods

PWH receiving care at 3 Southeastern US academic HIV clinics between January 2014 and December 2016 were retrospectively stratified into 5 groups based on the specialty of the clinician managing their hypertension or hyperlipidemia. Patients were followed until first atherosclerotic cardiovascular disease event, death, or end of study. Outcomes of interest were meeting 8th Joint National Commission (JNC-8) blood pressure (BP) goals and National Lipid Association (NLA) non-high-density lipoprotein (HDL) goals for hypertension and hyperlipidemia, respectively. Point estimates for associated risk factors were generated using modified Poisson regression with robust error variance.

Results

Of 1667 PWH in the analysis, 965 had hypertension, 205 had hyperlipidemia, and 497 had both diagnoses. At study start, the median patient age was 52 years, 66% were Black, and 65% identified as male. Among persons with hypertension, 24% were managed by an infectious diseases (ID) clinician alone, and 5% were co-managed by an ID clinician and a primary care clinician (PCC). Persons managed by an ID clinician were less likely to meet JNC-8 hypertension targets at the end of observation than the rest of the cohort (relative risk [RR], 0.84; 95% CI, 0.75-0.95), but when mean study blood pressure was considered, there was no difference between persons managed by ID and the rest of the cohort (RR, 0.96; 95% CI, 0.88-1.05). There was no significant association between the ID clinician managing hyperlipidemia and meeting NLA non-HDL goals (RR, 0.89; 95% CI, 0.68-1.15).

Conclusions

Clinician specialty may play a role in suboptimal hypertension outcomes in persons with HIV.
dc.identifier

ofaa361

dc.identifier.issn

2328-8957

dc.identifier.issn

2328-8957

dc.identifier.uri

https://hdl.handle.net/10161/26703

dc.language

eng

dc.publisher

Oxford University Press (OUP)

dc.relation.ispartof

Open forum infectious diseases

dc.relation.isversionof

10.1093/ofid/ofaa361

dc.subject

HIV

dc.subject

cardiovascular disease

dc.subject

health services

dc.subject

hyperlipidemia

dc.subject

hypertension

dc.title

Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?

dc.type

Journal article

duke.contributor.orcid

Naggie, Susanna|0000-0001-7721-6975

duke.contributor.orcid

Bloomfield, Gerald S|0000-0002-7176-1611

duke.contributor.orcid

Bosworth, Hayden B|0000-0001-6188-9825

pubs.begin-page

ofaa361

pubs.issue

9

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Basic Science Departments

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Institutes and Centers

pubs.organisational-group

Family Medicine and Community Health

pubs.organisational-group

Medicine

pubs.organisational-group

Medicine, Cardiology

pubs.organisational-group

Medicine, General Internal Medicine

pubs.organisational-group

Medicine, Infectious Diseases

pubs.organisational-group

Duke Cancer Institute

pubs.organisational-group

Duke Clinical Research Institute

pubs.organisational-group

Institutes and Provost's Academic Units

pubs.organisational-group

University Institutes and Centers

pubs.organisational-group

Duke Global Health Institute

pubs.organisational-group

Center for the Study of Aging and Human Development

pubs.organisational-group

Initiatives

pubs.organisational-group

Duke Science & Society

pubs.organisational-group

Population Health Sciences

pubs.organisational-group

Duke Innovation & Entrepreneurship

pubs.organisational-group

Duke - Margolis Center For Health Policy

pubs.publication-status

Published

pubs.volume

7

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Cardiovascular Disease Risk Management in Persons With HIV Does Clinician Specialty Matter.pdf
Size:
159.66 KB
Format:
Adobe Portable Document Format