615 - Overlooking those at Intermediate Risk? ASCVD Prevention Measures among People Living with HIV at an Urban Academic Medical Center

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Presenting Author(s)

Mark Liotta

Medical Student
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Peter Cangialosi

Medical Student
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JH

Jeanne Ho

Resident
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DF

Diana Finkel

Assistant Professor
Rutgers NJMS
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Shobha Swaminathan

Associate Professor
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SK

Steven Keller

Professor
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: The American College of Cardiology (ACC) recognizes HIV as a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, 2019 guidelines do not address people living with HIV (PLWH), aside from stating that their Risk Estimator Plus tool, which is used to calculate a 10-year risk for ASCVD and advise management, likely underestimates CVD risk in PLWH. This quality assessment project examines rates of ACC guideline adherence for ASCVD prevention for PLWH who have calculated risk scores in the low (< 7.5%), intermediate (> 7.5% & < 20%), and high-risk (> 20%) ranges. Patients analyzed are from an HIV registry of University Hospital Infectious Disease Outpatient clinic in Newark, NJ. The clinic’s 2451 total patients are 40% female, 63% non-Hispanic black, 23% Hispanic, and 64% > 45 years old.

Methods: This project was approved by the Rutgers IRB. Patients (40-79 years) with a clinic visit from 2/1/2019 to 1/31/2020 were reviewed. ASCVD risk scores were calculated using the Risk Estimator Plus for all patients when data was available. Guideline adherence rate was defined as following 2019 ACC guidelines for appropriate statin therapy, while considering medication interactions.

Results: Of the 1127 patients who met criteria, 744 ASCVD risk scores were calculated. Lipid values outside the calculator range (229) or no documented lipids (154) resulted in non-calculatable scores. Guideline adherence rate for the intermediate-risk group was significantly less than the high-risk and low-risk groups (P< 0.05): low-risk 92.8% (95% CI 90.0-95.1, n=346), intermediate-risk 35.2% (95% CI 29.7-41.1, n=270), and high-risk 52.3% (95% CI 43.8-60.8, n=128). Adherence rates within the intermediate-risk group for patients with hypertension (HTN) and smokers were significantly less than those with CVD (P< 0.05). Table 1: Patients with Calculated ASCVD Risk Score > 20 for PLWH from 2/1/2019 – 1/31/2020

Table 2: Patients with Calculated ASCVD Risk Score > 7.5 & < 20 for PLWH from 2/1/2019 – 1/31/2020

Table 3: Patients with Calculated ASCVD Risk Score < 7.5 for PLWH from 2/1/2019 – 1/31/2020

Conclusion: Lower overall guideline adherence rates within the intermediate risk group, and particularly among those with a history of HTN and smoking, highlights the need for targeted care. Provider education on the calculation and application of ASCVD risk scores, as well as increased awareness of the risk-enhancing nature of HIV infection in coexistence with the traditional risk factors of CVD history, diabetes, HTN, and smoking are important steps to increase adherence rates.