Venous thromboembolism in heart failure: preventable deaths during and after hospitalization
Department of Medicine, Division of Cardiovascular Medicine; Department of Quantitative Health Sciences
Medical Subject Headings
Adult; Aged; Female; Heart Failure; Heart Failure, Diastolic; Heart Failure, Systolic; Hospital Mortality; *Hospitalization; Humans; Inpatients; Male; Massachusetts; Middle Aged; Pulmonary Embolism; Time Factors; Treatment Outcome; Venous Thromboembolism
Biostatistics | Cardiology | Epidemiology | Health Services Research
OBJECTIVE: Our aim was to compare the clinical characteristics, prophylaxis, treatment, and outcomes of patients with venous thromboembolism with and without heart failure.
METHODS: We studied patients with heart failure in the population-based Worcester Venous Thromboembolism Study of 1822 consecutive patients with validated venous thromboembolism.
RESULTS: Of the 1822 patients with venous thromboembolism, 319 (17.5%) had a history of clinical heart failure and 1503 (82.5%) did not. Patients with heart failure were older (mean age 75 vs 62 years, P<.0001) and more likely to have been immobilized (65.2% vs 46.1%, P<.0001). Thromboprophylaxis was omitted in approximately one third of patients with heart failure who had been hospitalized for non-venous thromboembolism-related illness or had undergone major surgery within the 3 months before diagnosis. Patients with heart failure had a higher frequency of in-hospital death (9.7% vs 3.3%, P<.0001) and death within 30 days of venous thromboembolism diagnosis (15.6% vs 6.4%, P<.0001). Heart failure (adjusted odds ratio [OR] 2.04; 95% confidence interval [CI], 1.15-3.62) and immobility (adjusted OR 4.37; 95% CI, 2.42-7.9) were associated with an increased risk of in-hospital death. Heart failure (adjusted OR 1.57; 95% CI, 1.01-2.43) and immobility (adjusted OR 3.05; 95% CI, 2.01-4.62) also were independent predictors of death within 30 days of venous thromboembolism diagnosis.
CONCLUSION: High mortality was observed among patients with heart failure and venous thromboembolism both during and after hospitalization. Heart failure and immobility are potent risk factors for in-hospital death and death within 30 days in patients with venous thromboembolism.
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Citation: Am J Med. 2011 Mar;124(3):252-9. Link to article on publisher's site