An audit of cardiovascular disease risk management in HIV-infected patients attending a northern English hospital

Purpose of the study

British HIV Association guidelines recommend that all HIV patients have lipids, glucose and blood pressure monitored annually and receive lifestyle modification advice if they have increased cardiovascular risk factors. The aim of the audit was to determine whether cardiovascular risk factors are being identified and managed appropriately in this population, especially regarding patients with increased risk factors.

Methods

A questionnaire was devised and completed by 50 patients visiting the James Cook University Hospital (JCUH) HIV outpatient clinic in Middlesbrough over a 5-week period. These patients' case notes were then reviewed. A proforma was used to collect data.

Summary of results

Annual measurements of glucose, cholesterol and triglyceride were recorded in 44%, 86% and 86%, respectively. 74% of the total patient population received dietetic referral. 24% were current smokers, 67% of whom were given cessation advice. 26% had a BMI greater than 25 kg/m², 100% of which were referred to the dietician, as were 80% of the 30% who had raised cholesterol. 10% had a weekly alcohol intake greater than the recommended limit, 20% of which were given advice. 62% either smoked or had more than one risk factor, 97% of which were given advice.

Conclusion

Identification and management of cardiovascular risk factors did not meet BHIVA guidelines. Doctors need to improve identification of cardiovascular risk factors through annual checks comprising blood pressure, fasting glucose and lipids. Although current management through dietetic referral is efficient, alcohol and smoking management needs improving. A re-audit following changes in policy is necessary.