Original Article

Readmissions among People Living with HIV Admitted for Hypertensive Emergency

Authors: Shantanu Patil, MD, Sanu Rajendraprasad, MD, Manasa Velagapudi, MBBS, Sarah Aurit, MPH, Venkata Andukuri, MD, Venkata Alla, MD

Abstract

Objectives: People with human immunodeficiency virus (HIV) are at an increased risk of developing cardiovascular diseases. Hypertensive emergency (HTNE), a complication of hypertension with potentially serious health implications, has high healthcare utilization. We attempted to determine the association between HIV status and risk for 30-day readmission after index hospitalization for HTNE.

Methods: We used the Nationwide Readmissions Database to identify all of the admissions during 2010–2017 with a primary discharge diagnosis of HTNE. Admissions were stratified by HIV status and comparisons were made with the χ2 test. We investigated predictors of all-cause 30-day readmission via multivariable logistic regression.

Results: A total of 612,854 hospitalizations with a primary discharge diagnosis of HTNE were identified, and 4115 (0.7%) were HIV positive. There was a total of 43,937 (7.16%) 30-day readmissions, and the rate was higher in regard to positive HIV status (29.8% vs 15.0%; P < 0.001). Renal failure was the most frequent reason for HIV readmissions and the second most frequent reason for non-HIV readmissions (15.6% vs 10.3%; P < 0.001). In contrast, heart failure was the most frequent reason for non-HIV readmissions and the second most frequent reason for HIV readmissions (10.3% vs 11.9%; P = 0.234). There was a higher median cost for HIV readmissions in comparison to non-HIV readmissions ($7660 vs $7490; P < 0.001). Finally, HIV was attributed to 40.6% increased odds of readmission after adjusting for pertinent clinical and demographic factors (P < 0.001).

Conclusions: HIV-positive status is associated with an increased risk for 30-day readmission after index hospitalization for HTNE.
Posted in: Hypertension8 Acquired Immunodeficiency Syndrome (AIDS) And Human Immunodeficiency Virus (HIV) Infection12

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References

1. Kirkland EB, Heincelman M, Bishu KG, et al. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003–2014. J Am Heart Assoc 2018;7:e008731.
 
2. Whelton PK, Carey RM, Aronow WS, et al. ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71:e13–e115.
 
3. Shah M, Patil S, Patel B, et al. Trends in hospitalization for hypertensive emergency, and relationship of end-organ damage with in-hospital mortality. Am J Hypertens 2017;30:700–706.
 
4. Kumar N, Simek S, Garg N, et al. Thirty-day readmissions after hospitalization for hypertensive emergency. Hypertension 2019;73:60–67.
 
5. World Health Organization. Key facts on HIV/AIDS. https://www.who.int/news-room/fact-sheets/detail/hiv-aids. Accessed May 25, 2022.
 
6. Centers for Disease Control and Prevention. HIV. Basic statistics. https://www.cdc.gov/hiv/basics/statistics.html. Accessed December 2, 2020.
 
7. Nduka CU, Stranges S, Sarki AM, et al. Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis. J Hum Hypertens 2016;30:355–362.
 
8. Armah KA, Chang CC, Baker JV, et al. Prehypertension, hypertension, and the risk of acute myocardial infarction in HIV-infected and -uninfected veterans. Clin Infect Dis 2014;58:121–129.
 
9. Fahme SA, Bloomfield GS, Peck R. Hypertension in HIV-infected adults: novel pathophysiologic mechanisms. Hypertension 2018;72:44–55.
 
10. Berry SA, Fleishman JA, Moore RD, et al. Thirty-day hospital readmissions for adults with and without HIV infection. HIV Med 2016;17:167–177.
 
11. Brouch D, Tashtish N, Di Felice C, et al. Human immunodeficiency virus infection and risk of heart failure rehospitalizations. Am J Cardiol 2019;124:1232–1238.
 
12. Kim LK, Yeo I, Cheung JW, et al. Thirty-day readmission rates, timing, causes, and costs after ST-segment-elevation myocardial infarction in the United States: a national readmission database analysis 2010–2014. J Am Heart Assoc 2018;7:e009863.
 
13. Healthcare Cost and Utilization Project. NRD description of data elements.https://www.cdc.gov/globalhivtb/who-we-are/success-stories/success-story-pages/integratinghivandhypertension.html. Accessed October 22, 2020.
 
14. Wang H, Zhao T, Wei X, et al. The prevalence of 30-day readmission after acute myocardial infarction: a systematic review and meta-analysis. Clin Cardiol 2019;42:889–898.
 
15. Marcus JL, Leyden WA, Alexeeff SE, et al. Comparison of overall and comorbidity-free life expectancy between insured adults with and without HIV infection, 2000–2016. JAMA Netw Open 2020;3:e207954.
 
16. Calvillo-King L, Arnold D, Eubank KJ, et al. Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. J Gen Intern Med 2013;28:269–282.
 
17. Xu Y, Chen X, Wang K. Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis. J Am Soc Hypertens 2017;11:530–540. .
 
18. Masenga SK, Hamooya BM, Nzala S, et al. Patho-immune mechanisms of hypertension in HIV: a systematic and thematic review. Curr Hypertens Rep 2019;21:56.
 
19. Foy M, Sperati CJ, Lucas GM, et al. Drug interactions and antiretroviral drug monitoring. Curr HIV/AIDS Rep 2014;11:212–222.
 
20. Burnier M, Egan BM. Adherence in hypertension. Circ Res 2019;124:1124–1140.
 
21. Naicker S, Rahmanian S, Kopp JB. HIV and chronic kidney disease. Clin Nephrol 2015;83:32–38.
 
22. Olaiya O, Weiser J, Zhou W, et al. Hypertension among persons living with HIV in medical care in the United States—Medical Monitoring Project, 2013–2014. Open Forum Infect Dis 2018;5:ofy028.
 
23. Kwarisiima D, Atukunda M, Owaraganise A, et al. Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study. BMC Public Health 2019;19:511.
 
24. Gupta T, Kolte D, Khera S, et al. Smoker’s paradox in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Am Heart Assoc 2016;5:e003370.
 
25. Elagizi A, Kachur S, Lavie CJ, et al. An overview and update on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis 2018; 61:142–150.
 
26. Pappas G, Yujiang J, Seiler N, et al. Perspectives on the role of patient-centered medical homes in HIV care. Am J Public Health 2014;104: e49–e53.
 
27. Centers for Disease Control. Integrating HIVand HTN Management. https:// https://www.cdc.gov/globalhivtb/who-we-are/success-stories/success-story-pages/integratinghivandhypertension.html. Accessed May 25, 2022.
 
28. Allen LN. Financing national non-communicable disease responses. Glob Health Action 2017;10:1326687.