February 8, 2010

Assessing cardio care for HIV/AIDS patients

In a three-year study of 700 Baltimore patients with HIV/AIDS, Jason Farley, an assistant professor in the Johns Hopkins School of Nursing, will explore the effectiveness of health care clinicians in preventing cardiovascular disease in HIV/AIDS patients.

“In an HIV/AIDS clinic population, we’re very focused on treating HIV, but we’re also involved in providing primary care,” Farley said. “The question of the study is: How good are we at preventing cardiovascular conditions when we have another life-threatening condition we’re paying attention to?”

Farley said he believes that early intervention would help greatly. Untreated HIV/AIDS has been known to increase cardiovascular problems; on the other hand, anti-retroviral therapy on HIV/AIDS patients carries risks, including heart attacks.

Through the study, Farley will examine the degree to which the clinicians screen their HIV/AIDS patients’ cardiovascular health by advising them on such matters as proper diet and weight, regular exercise and smoking cessation. He also will evaluate how well they control such conditions as hypertension and diabetes that affect cardiovascular disease and that may be affected by HIV/AIDS or its treatment.

Health care professionals’ being “strapped for time” during appointments means less opportunity to address HIV/AIDS patients’ overall condition, including cardiovascular health, Farley said. Meanwhile, cardiovascular disease, or CVD—the leading cause of morbidity and mortality in the United States—is an increasing, non-AIDS–related cause of morbidity and mortality in people with HIV/AIDS.

The pilot project also will develop an automated system for tracking the screening procedures and assessing providers’ adherence to the American Heart Association’s guidelines for the prevention of cardiovascular disease. The tracking method—known as ASPIRE, for Automated System to Prevent Cardiovascular Disease in HIV CaRE Settings—“has significant potential to improve HIV providers’ adherence to evidence-based primary prevention practices, a result that should translate into reductions in CVD morbidity and mortality among vulnerable patient populations with HIV/AIDS,” Farley said.

“I want to see how good we are at putting patients on lipid therapy, keeping their blood pressure under control, using prophylactic aspirin—at preventing heart disease among patients with HIV/AIDS,” Farley said.

The study is being funded through a National Institute of Nursing Research grant to the School of Nursing’s Center for Excellence for Cardiovascular Health in Vulnerable Populations.