High Incidence of Patients Lost to Follow-up After Venous Thromboembolism Diagnosis—Identifying an Unmet Need for Targeted Transition of Care

Abstract

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), affects approximately 5% of the population, and approximately 30% of affected individuals will die within 30 days of diagnosis. Given the prevalence of VTE and its associated mortality, our study evaluated the success of longitudinal treatment in patients diagnosed with VTE with particular attention to those lost to appropriate follow-up. This is a single-center retrospective study of all consecutive admitted (inpatient [IP]) and emergency department (ED) patients diagnosed with acute VTE by venous duplex ultrasound examination or chest computed tomography from January 2018 to March 2019. Patients with chronic DVT and those diagnosed in the outpatient setting were excluded. Data collected included age, sex, clinical setting at time of diagnosis, discharge anticoagulation choice, discharge disposition, and clinical follow-up. Lost to VTE follow-up (LTFU) was defined as those patients who did not follow up with vascular, cardiovascular, hematology/oncology, pulmonology, or primary care clinic for VTE management at our institution within 3 months after discharge. Patients discharged to hospice were excluded from LTFU analysis. Statistical analysis was performed using Stata 16 software (StataCorp LLC, College Station, Tex) and a threshold P value of < .05 set for significance. During the study period, 291 DVTs (237 lower extremity DVTs, 58 upper extremity DVTs, 4 mixed), 25 isolated PEs, and 55 PEs with associated DVT (53 lower extremity DVTs, 2 upper extremity DVTs) were identified in 371 patients. Of these patients, 130 (35%) were diagnosed in the ED and 241 (65%) in the IP setting. At discharge, 291 (78.4%) were receiving anticoagulation, 64 (17.3%) were not, and 16 (4.3%) were deceased. Ultimately, 133 patients (35.9%) were LTFU, 85% of whom were discharged on anticoagulation. There was no statistically significant difference between those LTFU with respect to age (P = .373), sex (P = .194), diagnosis time of day (P = .272), VTE type (P = .367), or discharge unit location (IP vs ED, 33.7% vs 43.8% LTFU; P = .114); however, there was a statistically significant association between longer IP length of stay and those patients LTFU in controlling for age (11.8 days vs 16.6 days; P = .028). This study demonstrates that more than one-third of patients diagnosed with VTE at our institution are LTFU, suggesting that significant improvement could be achieved by establishing a pathway for the targeted transition of care to a VTE-specific follow-up clinic.