Abstract MP23: Heart Failure is Associated With Incident Venous Thromboembolism: the Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background: Heart failure (HF) hospitalization places patients at increased short-term risk of venous thromboembolism (VTE). However, the degree to which incident HF is a long-term risk factor for VTE is less clear, and it is unknown if the association differs by type of HF. We assessed the association between HF and VTE in the ARIC study. Methods: Our analysis included 10,495 participants (22% black race, 59% female, mean age 62) who were initially free of HF, cancer, and VTE in 2005. We identified incident HF from hospitalization records starting in 2005, and when possible HF was further subcategorized from hospital record review as HF with preserved ejection fraction ≥50% (HFpEF) or reduced ejection fraction of <50% (HFrEF). Incident VTE was adjudicated by physician review and classified as pulmonary embolism (PE) or deep venous thrombosis (DVT), and provoked or unprovoked. We used Cox proportional hazards models to evaluate the association between time-dependent HF and incident VTE. Follow-up time accrued from 2005 until date of VTE, loss to follow-up, death, or the end of 2015, whichever came first. Results: During a mean follow-up of 10 years, we identified 1005 participants who developed hospitalized HF (28% HFpEF; 27% HFrEF) and 262 who had incident VTE events. Incident HF was associated with a significantly higher risk of subsequent incident VTE: multivariable hazard ratio (HR) 5.15, 95% confidence interval (CI) 3.80-6.98. The risk of VTE was similar for HFpEF and HFrEF; HR (95% CI) = 4.71 (2.94-7.52) and 5.53 (3.42-8.94), respectively. The risk was similar when the VTE outcome was subclassified as PE or DVT or as provoked or unprovoked. Conclusion: In this large population-based study, incident HF was associated with a greatly increased risk of VTE, and the risk was similar in participants with HFpEF and HFrEF. Health care providers should consider possible evidence-based strategies to prevent VTE in HF patients, regardless of HF classification.