Abstract 4367774: Outcomes of HIV-Positive Patients with Cardiac Implantable Electronic Device–Related Infective Endocarditis (CIED-IE): A Prospensity Score-Matched Analysis of National Inpatient Sample Data(2016-2022)

Abstract

Introduction: Cardiac Implantable Electronic Device-related Infective Endocarditis (CIED-IE) is a common cause of hospitalization, and is associated with significant morbidity and mortality. Its incidence and prevalence are increasing as the use of implantable devices has increased over the years. Despite the potential for more rapid disease progression in HIV-positive patients with CIED-IE, national-level outcome data remain limited. This study aims to evaluate outcomes among HIV-positive patients who were diagnosed with CIED-IE using current national data. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2016-2022. Adult hospitalizations with a primary or secondary diagnosis of CIED-IE were identified using ICD-10 codes validated in prior studies. HIV status was determined from diagnosis fields. We conducted a 1:1 Nearest neighbor propensity score matching using baseline demographics and comorbidities to mitigate potential confounders. The balance between groups was assessed using standardized mean differences. The primary outcome was in-hospital mortality, assessed using Kaplan-Meier survival analysis. Secondary outcomes included length of stay (LOS), total hospitalization costs, device removal, and other complications associated with CIED-IE. Results: A total of 569 matched pairs were included in the analysis. The mean age of the cohort was 52.7 years(SD = 12) with 37.3% being females. Racial and ethnic composition of the cohort was 75% Blacks, 15.7% Whites, 6.6% Hispanic and 0.4% Asian and Pacific Islanders. The overall in-Hospital mortality was significantly lower in HIV-positive patients.(2.3% vs 6.0%, p = 0.026) Kaplan-Meier curves demonstrated a significantly lower in-hospital mortality risk among HIV-positive patients (HR = 0.48 95% CI [0.25, 0.91] p = 0.026). There was no significant difference in the median length of hospital stay or cost of hospitalization. HIV-Positive patients had lower rates of AKI(OR = 0.62 95% CI [0.44, 0.89] p = 0.01), Device extraction (OR = 0.47 95% CI [0.29, 0.77] p = 0.03), and Cerebrovascular accidents(HR = 0.39 95% CI [0.20, 0.79] p = 0.026). Conclusion: Among hospitalized patients with CIED-IE, HIV-positive patients have significantly lower in-hospital mortality with no significant differences in hospital length of stay and costs. In addition HIV patients have lower rates of complications of CIED-IE such as AKI, Device extraction and Cerebrovascular accidents.