Background: Though the advent of highly active anti-retroviral medications has improved survival in HIV infection, mortality from non-infectious complications such as pulmonary arterial hypertension (PAH) has increased. Also, studies have shown that PAH is the leading cause of hospitalization and death in patients with HIV associated PAH (HIV-PAH). However, not much is known about the length of hospital stay (LOS), an indicator of healthcare resource utilization and the different discharge outcomes in hospitalized patients with HIV-PAH
Methods: We conducted a retrospective analysis of the National Hospital Discharge Survey data for the time period 2001–2010. Cases of HIV infection or AIDS were identified using ICD-9 codes 042, 043, 044, 079.53, and V08 in any of the discharge diagnoses. PAH was identified using ICD-9 code 416.0. We determined the prevalence of HIV-PAH in the cohort stratified by age, sex, and race. LOS in patients with HIV-PAH was compared with non-PAH HIV infected patients. We also evaluated and compared the discharge status between the two groups. In-hospital mortality in both groups was calculated on the basis of patients whose discharge status was listed as death and logistic regression was used to determine the odds of mortality. All analysis was carried out using STATA 13 for MAC.
Results: Seven hundred ninety-seven of 1,944,388 discharged patients with HIV infection were identiﬁed as having HIV-PAH, leading to an estimated prevalence of 0.04%. The mean age (±SD) of the cohort was 44 years (±7.5) and African Americans (AA) had a higher prevalence of HIV-PAH than whites (0.05% vs. 0.009%). HIV-PAH prevalence was also higher in females than males (0.061% vs. 0.037%). LOS was longer in patients with HIV-PAH than non-PAH HIV (9.8 days vs. 5.3 days, P < 0.05). The most common discharge status for patients with HIV-PAH was discharge to home (81.7%) followed by leaving against medical advice (LAMA) (8.1%), death (8%), and long-term acute facilities (LTAC) (1.8%). While in patients with non – PAH HIV, 74% were discharged home, 2% LAMA, 4.2% were listed as dead, and 7.7% transferred to LTAC. The differences between the percentage of patients in both groups were statistically signiﬁcant for all categories of discharge status reviewed (P < 0.05). Patients with HIV-PAH were more likely to have a mortality outcome at discharge compared to non-PAH HIV patients independent of race or sex (OR 2.98. 95% CI: 1.67 – 3.2).
Conclusions: Our study demonstrates significantly higher LOS and increased risk of mortality in patients with HIV-PAH compared to non HIV-PAH. Though the HIV-PAH group had a higher percentage of patients discharged home, the significantly higher proportion of patients LAMA may lead to poorer outcomes overall. The findings from this study further underscore the need for clinicians to diagnose and treat PAH in HIV infected patients. Under-reporting and under-diagnosis may contribute to the low prevalence of HIV-PAH noted in this study and future research should evaluate the cost-effectiveness and benefits of screening for PAH in HIV infected patients.