Acute and Chronic Care, Johns Hopkins School of Nursing
Decision Support for Improved Cardiovascular Risk Management among HIV-Positive Individuals
In persons with HIV/AIDS, cardiovascular disease (CVD) results from a complex interplay of traditional lifestyle factors, metabolic changes associated with ART, and inflammatory responses associated with chronic viral infection. CVD prevalence estimates among HIV-positive persons range from 28% to 73% and untreated HIV has been directly linked to atherosclerosis and cardiomyopathy. In addition to the direct influence of HIV infection and its associated treatment, modifiable risk factors associated with CVD, including smoking, physical inactivity, substance abuse, poor nutrition, and inadequate access to primary healthcare are prevalent in this population. Despite increased risk, CVD can be limited in HIV-infected patients by modifying traditional risk factors. Evidence-based guidelines for CVD prevention in persons with HIV/AIDS exist. However, despite high CV risk burden and widely-promulgated guidelines, management of CV risk factors (BP, dylipidemias, diabetes, smoking, diet, and physical inactivity) is suboptimal. Clinical decision support systems have significant potential for improving adherence to CVD prevention guidelines and improving CV outcomes in HIV/AIDS care settings. We propose to develop and pilot test provider clinical decision support embedded in the electronic health record (HER) that is individually-tailored to patients’ clinical parameters to promote CV risk reduction in the HIV care setting. This system-level, technology-based intervention has high potential for translation across primary care and specialty care settings to prevent CVD and promote health aging among individuals with HIV/AIDS.