Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?
Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?
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DOI：
10.1093/ofid/ofaa361
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发表时间：
2020-09
影响因子：
4.2
通讯作者：
Bosworth HB
中科院分区：
文献类型：
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作者：
Okeke NL;Schafer KR;Meissner EG;Ostermann J;Shah AD;Ostasiewski B;Phelps E;Kieler CA;Oladele E;Garg K;Naggie S;Bloomfield GS;Bosworth HB
临床医生专业对HIV(PWH)患者心血管疾病危险因素结局的影响尚不清楚。根据临床医生处理高血压或高脂血症的专业，将2014年1月至2016年12月在美国东南部3家学术艾滋病毒诊所接受治疗的PWH分为5组。对患者进行跟踪，直到第一次动脉粥样硬化性心血管疾病事件、死亡或研究结束。令人感兴趣的结果是分别达到了第8个国家联合委员会(JNC-8)高血压和高脂血症的血压(BP)目标和国家脂质协会(NLA)的非高密度脂蛋白(HDL)目标。相关风险因素的点估计使用具有稳健误差方差的修正泊松回归产生。在参与分析的1667名PWH患者中，965人患有高血压，205人患有高脂血症，497人同时患有高血压和高脂血症。在研究开始时，患者的平均年龄为52岁，66%是黑人，65%是男性。在高血压患者中，24%由传染病(ID)临床医生单独管理，5%由ID临床医生和初级保健临床医生(PCC)共同管理。在观察结束时，由独立临床医生管理的人比队列中的其他人更不可能达到JNC-8高血压目标(相对风险[RR]，0.84；95%CI，0.75-0.95)，但当考虑到平均研究血压时，由ID临床医生管理的人与队列中其他人之间没有差异(RR，0.96；95%CI，0.88-1.05)。ID临床医生管理高脂血症和达到NLA非高密度脂蛋白目标之间没有显著关联(RR，0.89；95%CI，0.68-1.15)。临床医生的专业可能在HIV携带者的次优高血压结局中发挥作用。在这项对美国东南部三个大型学术中心的艾滋病毒门诊数据进行的回溯性研究中，临床医生的专业知识可能对艾滋病毒携带者达到循证心血管疾病风险因素目标的频率起到作用。
The impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear. 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. 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). Clinician specialty may play a role in suboptimal hypertension outcomes in persons with HIV. In this retrospective study of HIV outpatient data from three large academic centers in the Southeastern United States, clinician specialty may play a role in how often evidence-based cardiovascular disease risk factor targets are met among persons living with HIV.
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影响因子：
5.4
作者：
Ladapo, Joseph A.;Richards, Adam K.;Mafi, John N.
通讯作者：
Mafi, John N.
影响因子：
39.2
作者：
Bosworth HB;Olsen MK;Grubber JM;Neary AM;Orr MM;Powers BJ;Adams MB;Svetkey LP;Reed SD;Li Y;Dolor RJ;Oddone EZ
通讯作者：
Oddone EZ
DOI：
10.1093/cid/ciw442
发表时间：
2016-10-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Weiser J;Beer L;West BT;Duke CC;Gremel GW;Skarbinski J
通讯作者：
Skarbinski J
影响因子：
4.4
作者：
Jacobson, Terry A.;Ito, Matthew K.;Brown, W. Virgil
通讯作者：
Brown, W. Virgil
影响因子：
--
作者：
Bosworth, Hayden B.;Powers, Benjamin J.;Oddone, Eugene Z.
通讯作者：
Oddone, Eugene Z.