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种族/族裔少数群体。这样的证据最终会 告知临床护理指南和卫生系统干预措施，以改善健康差距 感染艾滋病毒的人群。因此，该提案的长期目标是产生以证据为基础的 PLWH心血管疾病风险管理建议。此应用程序的总体目标是 在不同种族的人群中展示心脏病转诊对心血管疾病健康结局的影响 艾滋病毒携带者(PLWH)队列，并产生定性和定量证据以指导 未来干预措施的发展。我们的中心假设是，心脏病转诊可以减少心血管疾病的发生 与非转介相比，黑人/非裔美国人和其他感染艾滋病毒的种族/族裔少数群体中的事件。这个 我们研究的理由是，一旦知道这些健康差距是如何影响艾滋病毒携带者的 心脏科转诊和随后对心血管疾病预后的影响，可以适当地进行干预 旨在测试新的和创新的方法来管理高架PLWH的共病 心血管疾病风险。我们计划测试我们的中心假设，从而实现我们的总体目标 以下三个具体目标：(目标1)衡量心脏病转诊和心血管疾病之间的联系 在感染艾滋病毒的人数不足的种族/族裔少数群体中的结果，(目标2)以确定个人--和健康 影响代表不足的种族/族裔少数群体的心血管疾病结果的系统一级因素，以及(目标3) 制定干预措施的定性框架，以改善PLWH的心血管疾病结局。我们将追溯 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级别数据，并 “心脏病发作带”，使用PCORnet的通用数据模型。我们将追溯性地确定非洲- 美国和其他代表性不足的少数族裔和非西班牙裔白人艾滋病毒携带者。开始 日期将是2010年1月1日之后的首次临床接触，以创建至少5年的当代队列 纵向随访。主要的自变量是去看心脏病专家，而不是去看医生 在第一次CVD活动之前进行这样的访问。我们的主要结果是心肌梗死，住院治疗 心力衰竭、中风、冠心病、5年后死亡或心血管死亡。我们的科学研究 预计贡献将是巨大的，因为我们正在解决PLWH的可怕健康合并症。我们的 该组织的努力可能有助于更好地了解艾滋病毒相关心血管疾病是如何影响治疗的 在感染艾滋病毒的代表不足的种族/族裔少数群体中的结果。作为拟议工作的结果， 我们期望确定为代表性不足的种族/族裔少数群体提供理想心血管疾病护理的潜在途径 艾滋病毒携带者。我们期待的结果将导致更好地整合和协调护理，并最终改善 艾滋病毒携带者健康差距人群的心血管疾病健康结局。

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.