Multimorbidity Burden and Incident Heart Failure Among People With and Without HIV: The HIV-HEART Study

Matthew T Mefford; Michael J Silverberg; Thomas K Leong; Rulin C Hechter; William J Towner; Alan S Go; Michael Horberg; Haihong Hu; Teresa N Harrison; Sue Hee Sung; Kristi Reynolds

doi:10.1016/j.mayocpiqo.2022.03.004

Multimorbidity Burden and Incident Heart Failure Among People With and Without HIV: The HIV-HEART Study

Mayo Clin Proc Innov Qual Outcomes. 2022 May 3;6(3):218-227. doi: 10.1016/j.mayocpiqo.2022.03.004. eCollection 2022 Jun.

Authors

Matthew T Mefford¹, Michael J Silverberg^{2

3

4}, Thomas K Leong², Rulin C Hechter^{1

3

5}, William J Towner^{1

6

7}, Alan S Go^{2

3

4

8

9}, Michael Horberg^{3

10}, Haihong Hu¹⁰, Teresa N Harrison¹, Sue Hee Sung², Kristi Reynolds^{1

3}

Affiliations

¹ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
² Division of Research, Kaiser Permanente Northern California, Oakland, CA.
³ Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
⁴ Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
⁵ Department of Epidemiology, University of California Los Angeles, Los Angeles, CA.
⁶ Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
⁷ Department of Infectious Disease, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
⁸ Department of Medicine, University of California, San Francisco, CA.
⁹ Department of Medicine, Stanford University, Palo Alto, CA.
¹⁰ Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD.

Abstract

Objective: To examine the association between multimorbidity burden and incident heart failure (HF) among people with HIV (PWH) and people without HIV (PWoH).

Patients and methods: The HIV-HEART study is a retrospective cohort study that included adult PWH and PWoH aged 21 years or older at Kaiser Permanente between 2000 and 2016. Multimorbidity burden was defined by the baseline prevalence of 22 chronic conditions and was categorized as 0-1, 2-3, and 4 or more comorbidities on the basis of distribution of the overall population. People with HIV and PWoH were followed for a first HF event, all-cause death, or up to the end of follow-up on December 31, 2016. Using Cox proportional hazard regression, hazard ratios and 95% CIs were calculated to examine the association between multimorbidity burden and incident HF among PWH and PWoH, separately.

Results: The prevalences of 0-1, 2-3, and 4 or more comorbidities were 83.3%, 13.0%, and 3.7% in PWH (n=38,868), and 82.2%, 14.3%, and 3.5% in PWoH (n=386,586), respectively. After multivariable adjustment, compared with people with 0-1 comorbidities, the hazard ratios of incident HF associated with 2-3 and 4 or more comorbidities were 1.33 (95% CI, 1.04-1.71) and 2.41 (95% CI, 1.78-3.25) in PWH and 2.10 (95% CI, 1.92-2.29) and 4.09 (95% CI, 3.64-4.61) in PWoH, respectively.

Conclusion: Multimorbidity was associated with a higher risk of incident HF among PWH and PWoH, with more prominent associations in PWoH and certain patient subgroups. The identification of specific multimorbidity patterns that contribute to higher HF risk in PWH may lead to future preventative strategies.

Keywords: CVD, cardiovascular disease; CVRN, Cardiovascular Research Network; HF, heart failure; KP, Kaiser Permanente; PWH, people with HIV; PWoH, people without HIV; aHR, adjusted hazard ratio.

Grants and funding

R01 HL132640/HL/NHLBI NIH HHS/United States