Out-Of-Hospital Cardiac Arrest More Likely to Occur in Patients With vs Without HIV

Out-of-hospital cardiac arrest is significantly more likely to occur among individuals with vs without HIV infection, with nearly 90% of HIV-positive individuals experiencing mortality within 1 month following its occurrence. These study findings were published in Clinical Infectious Diseases.

Researchers performed a nationwide, population-based cohort study to assess the incidence, characteristics, and outcomes of out-of-hospital cardiac arrest among patients with HIV infection. Data for this analysis were captured between 2001 and 2019. The primary outcome was out-of-hospital cardiac arrest, and data on its occurrence were obtained from the Danish Cardiac Arrest Register. Other assessed outcomes included the rate of 30-day and 1-year survival. The researchers also compared differences in the rate of out-of-hospital cardiac arrest between patients with vs without HIV infection. A multivariable Cox regression analysis was performed to investigate risk factors for cardiac arrest. Adjustments were made for HIV status, sex, hypertension, diabetes, heart failure, ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease, cancer, and kidney failure.

A total of 6,565,309 patients were included in the analysis, of whom 6925 were positive for HIV infection. The median age was similar between patients with vs without HIV infection (36 vs 35 years), though the percentage of men was higher among HIV-positive patients (74% vs 51%).

During a median follow-up period of 18.6 years, 111 (1.6%) patients with and 56,095 (0.9%) without HIV infection experienced cardiac arrest. The incidence of out-of-hospital cardiac arrest was 149 per 100,000 person-years among HIV-positive patients and 64 per 100,000 person-years among HIV-negative patients (incidence rate ratio [IRR], 2.33; 95% CI, 1.92-2.79).

Among patients with HIV infection, out-of-hospital cardiac arrest occurred more often among men (IR, 167; 95% CI, 134-205) than women (IR, 103; 95% CI, 64-158; P =.048). Of patients with vs without infection, cardiac arrest was more likely to occur among both HIV-positive men (IRR, 1.99; 95% CI, 1.60-2.43) and HIV-positive women (IRR, 2.38; 95% CI, 1.50-3.55).

Similar results were observed in the adjusted analysis, with the risk for out-out-hospital cardiac arrest increased among patients with vs without HIV infection (hazard ratio, 2.84; 95% CI, 2.36-3.43; P <.0001). The occurrence of out-of-hospital cardiac arrest among HIV-positive patients was most commonly attributed to heart disease (73%), followed by trauma (6%) and suicide (3%). For 18% of patients with HIV infection, the cause of cardiac arrest was unable to be determined.

The mean age at the time of cardiac arrest was lower among patients with vs without HIV infection (52 vs 69 years; P <.001). However, the rate of mortality at 30 days (89% vs 88%; P =.078) and at 1 year (90% vs 89%; P =.083) did not significantly differ between HIV-positive vs HIV-negative patients. Overall, HIV infection was not significantly associated with 30-day mortality following the occurrence of out-out-hospital cardiac arrest.

Study limitations include the lack of data on patient weight, smoking status, and substance use. Data on HIV viral load and CD4⁺ cell count also were not captured from HIV-positive patients.

According to the researchers, “These results should initiate further research into the mechanism associated with the higher risk of OHCA [out-of-hospital cardiac arrest] in PWH [people with HIV].”

This article originally appeared on Infectious Disease Advisor