Abstract 214: Trends in Venous Thromboembolism in Hospitalized Heart Failure Patients in the United States: Analysis of the 2002 to 2011 Nationwide Inpatient Sample Database

Abstract

Background: Hospitalized patients with heart failure (HF) are at increased risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and these conditions are associated with increased in-hospital mortality, longer length of stay and higher healthcare costs. Guidelines have emphasized the need for DVT prophylaxis, but it is unclear if the incidence of VTE has changed or remained constant over the past years. Objectives: To determine temporal trends in incidence and outcomes of VTE in hospitalized HF patients. Methods: We used the 2002 to 2011 Nationwide Inpatient Sample databases to identify all HF-associated hospitalizations in patients aged ≥18 years. Patients with VTE (DVT or PE) were then identified using appropriate ICD-9-CM codes. We stratified patients according to age, gender, and primary or secondary HF hospitalizations. Logistic regression analysis was used to examine temporal trends in incidence and outcomes of VTE as well as to compare outcomes between HF patients with or without VTE. Results: The overall incidence of DVT, PE and VTE among 42,573,726 HF-associated hospitalizations was 1.5%, 1.0% and 2.5%, respectively. From 2002 to 2011, there was a significant increase in the incidence of DVT (1.2% to 1.6%, adjusted OR 1.35, 95% CI 1.33-1.36), PE (0.8% to 1.2%, adjusted OR 1.91, 95% CI 1.88-1.93), and VTE (2.0% to 2.8%, adjusted OR 1.56, 95% CI 1.55-1.58). Similar upward trend was observed in all age groups, men and women, as well as primary and secondary HF hospitalizations. In-hospital mortality decreased in HF patients without VTE (6.9% to 5.0%; adjusted OR 0.81, 95% CI 0.80-0.81) as well as those with VTE (13.3% to 9.8%, adjusted OR 0.79, 95% CI 0.74-0.85) during the study period. However, compared to HF patients without VTE, those with VTE had significantly higher in-hospital mortality, longer length of stay, and higher total hospital charges (Table). Conclusion: Despite the aggressive guidelines for DVT prophylaxis, the overall incidence of VTE in hospitalized HF patients has increased over the past 10 years. This may be explained by increasing co-morbidities and aging of the HF population. Further studies are needed to explain these adverse trends and to examine rates of adherence to VTE prophylaxis guidelines in this high-risk patient population.