Pathways to cardiovascular disease prevention and impact of specialty referral in under-represented racial/ethnic minorities with HIV

迫切需要确定预防心血管疾病（CVD）的途径， 代表感染艾滋病毒和心血管风险升高的少数种族/族裔。这些证据最终将 为临床护理指南和卫生系统干预提供信息，以改善健康差距 艾滋病毒感染者。因此，该提案的长期目标是产生基于证据的 PLWH中CVD风险管理的建议。本申请的总体目标是 在一个大的种族/民族多样化的社区中，证明心脏病转诊对CVD健康结局的影响。 艾滋病毒感染者（PLWH）的队列，并产生定性和定量证据，以指导 发展未来的干预。我们的中心假设是，心脏病转诊减少了心血管事件 与非转诊相比，黑人/非裔美国人和其他少数种族/族裔艾滋病毒感染者的事件。的 我们研究的基本原理是，一旦知道这些健康差异如何影响艾滋病毒感染者的健康， 心脏病学转诊以及对CVD结局的后续影响，可以适当地 旨在测试新的和创新的方法，以管理合并症的PLWH在升高 CVD风险。我们计划检验我们的中心假设，从而实现我们的总体目标， 以下三个具体目标：（目的1）测量心脏科转诊与CVD之间的关系 在感染艾滋病毒人数不足的种族/族裔少数群体中取得的成果，（目标2） 影响代表性不足的种族/族裔少数群体心血管疾病结局的系统层面因素，以及（目标3） 制定干预措施的定性框架，以改善艾滋病毒携带者的心血管疾病结局。我们将回顾 分析来自美国东南部“艾滋病毒带”机构的电子健康记录中的患者水平数据， “心脏病发作带”，使用PCORnet的通用数据模型。我们将回顾性地确定非洲人的队列- 美国和其他代表性不足的种族/少数民族和非西班牙裔白色艾滋病毒患者。开始 日期将是2010年1月1日之后的首次临床联系，以创建至少5年的当代队列， 纵向跟踪。主要的自变量是心脏病专家的门诊访视， 在第一次CVD事件之前进行此类访视。我们的主要结局是心肌梗死， 5年后心力衰竭、中风、冠心病、死亡或心血管死亡。我们的科学 预计捐款将是巨大的，因为我们正在解决艾滋病毒携带者的可怕健康问题。我们 该小组的努力可能有助于更好地理解艾滋病毒相关的心血管疾病如何影响治疗 在感染艾滋病毒人数不足的种族/族裔少数群体中取得的成果。由于拟议的工作， 我们希望为代表性不足的种族/少数民族确定理想的CVD护理的潜在途径 感染了艾滋病毒我们预期的结果，导致更好的整合和协调的照顾，并最终改善 CVD健康结果的健康差距人群与艾滋病毒。

There is an urgent need to determine pathways to cardiovascular disease (CVD) prevention for under- represented racial/ethnic minorities with HIV and elevated cardiovascular risk. Such evidence will ultimately inform clinical care guidelines and health system interventions to improve health for health disparity populations with HIV. Thus, the long-term goal of this proposal is to generate evidence-based recommendations for the management of CVD risk in PLWH. The overall objectives of this application are to demonstrate the effect of cardiology referral on CVD health outcomes in a large racially/ethnically diverse cohort of people living with HIV (PLWH), and to generate qualitative and quantitative evidence to guide development of a future intervention. Our central hypothesis is that cardiology referral reduces incident CVD events in Blacks/African-Americans and other racial/ethnic minorities with HIV compared to non-referral. The rationale for our research is that, once it is known how these health disparity populations with HIV access cardiology referrals and the subsequent impact on CVD outcomes, an interventional can be appropriately designed to test new and innovative approaches to the management of co-morbidities for PLWH at elevated CVD risk. We plan to test our central hypothesis and thereby accomplish our overall objectives by pursuing the following three specific aims: (Aim 1) To measure the association between cardiology referral and CVD outcomes in under-represented racial/ethnic minorities with HIV, (Aim 2) To identify the individual- and health system-level factors that impact CVD outcomes for under-represented racial/ethnic minorities, and (Aim 3) To develop a qualitative framework for an intervention to improve CVD outcomes in PLWH. We will retrospectively analyze patient-level data from electronic health records from institutions in the U.S. Southeast “HIV-belt” and “Heart Attack belt”, using PCORnet’s Common Data Model. We will retrospectively identify cohorts of African- American and other under-represented racial/ethnic minorities and non-Hispanic white patients with HIV. Start date will be first clinical contact after January 1, 2010 to create a contemporary cohort with at least 5 years of longitudinal follow-up. The main independent variable is a clinic visit with a cardiologist, compared to not having such a visit, prior to first CVD event. Our primary outcome is myocardial infarction, hospitalization for heart failure, stroke, coronary heart disease, death or cardiovascular death after 5 years. Our scientific contribution is expected to be significant because we are addressing a dire health comorbidity for PLWH. Our group’s efforts are likely to contribute to greater understanding of how HIV-related CVD effects treatment outcomes among under-represented racial/ethnic minorities with HIV. As a consequence of the work proposed, we expect to identify the underlying pathways to ideal CVD care for under-represented racial/ethnic minorities with HIV. We anticipate results that lead to better integration and coordination of care and ultimately improve CVD health outcomes for health disparity populations with HIV.