Author + information
- Received November 9, 2011
- Revision received February 21, 2012
- Accepted February 27, 2012
- Published online May 22, 2012.
- Zian H. Tseng, MD, MAS⁎,⁎ (, )
- Eric A. Secemsky, MD†,
- David Dowdy, MD, PhD, ScM‡,
- Eric Vittinghoff, PhD, MPH§,
- Brian Moyers, MD⁎,
- Joseph K. Wong, MD∥,
- Diane V. Havlir, MD¶ and
- Priscilla Y. Hsue, MD#
- ↵⁎Reprint requests and correspondence:
Dr. Zian H. Tseng, University of California–San Francisco, Cardiac Electrophysiology Section, Cardiology Division, 500 Parnassus Avenue, MU-433, Box 1354, San Francisco, California 94143-1354
Objectives The aim of this study was to determine the incidence and clinical characteristics of sudden cardiac death (SCD) in patients with human immunodeficiency virus (HIV) infection.
Background As the HIV-infected population ages, cardiovascular disease prevalence and mortality are increasing, but the incidence and features of SCD have not yet been described.
Methods The records of 2,860 consecutive patients in a public HIV clinic in San Francisco between April 2000 and August 2009 were examined. Identification of deaths, causes of death, and clinical characteristics were obtained by search of the National Death Index and/or clinic records. SCDs were determined using published retrospective criteria: 1) the International Classification of Diseases-10th Revision, code for all cardiac causes of death; and (2) circumstances of death meeting World Health Organization criteria.
Results Of 230 deaths over a median of 3.7 years of follow-up, 30 (13%) met SCD criteria, 131 (57%) were due to acquired immune deficiency syndrome (AIDS), 25 (11%) were due to other (natural) diseases, and 44 (19%) were due to overdoses, suicides, or unknown causes. SCDs accounted for 86% of all cardiac deaths (30 of 35). The mean SCD rate was 2.6 per 1,000 person-years (95% confidence interval: 1.8 to 3.8), 4.5-fold higher than expected. SCDs occurred in older patients than did AIDS deaths (mean 49.0 vs. 44.9 years, p = 0.02). Compared with AIDS and natural deaths combined, SCDs had a higher prevalence of prior myocardial infarction (17% vs. 1%, p < 0.0005), cardiomyopathy (23% vs. 3%, p < 0.0005), heart failure (30% vs. 9%, p = 0.004), and arrhythmias (20% vs. 3%, p = 0.003).
Conclusions SCDs account for most cardiac and many non-AIDS natural deaths in HIV-infected patients. Further investigation is needed to ascertain underlying mechanisms, which may include inflammation, antiretroviral therapy interruption, and concomitant medications.
This work was supported by grants 5R01 HL102090 (Dr. Tseng), 5R01 HL095130 (Dr. Hsue), and 5R01 HL091526 (Dr. Hsue) from the National Heart, Lung, and Blood Institute; Veterans Affairs Merit Review grant R01 NS501132 (Dr. Wong); and grant K24 AI51982 (Dr. Havlir) from the National Institutes of Health. Dr. Tseng has also received minor honorarium from Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 9, 2011.
- Revision received February 21, 2012.
- Accepted February 27, 2012.
- American College of Cardiology Foundation