Venous Thromboembolism in Hospitalized Patients With Heart Failure

Abstract

Heart failure (HF) is a common cardiovascular cause of hospitalizations in the United States and the most frequent reason among patients aged 65 years and older.1 A recent report by the National Hospital Discharge Survey showed an increase in the number of hospital admissions with a diagnosis of HF from ≈1.3 million in 1979 to 3.9 million in 2004, with 30% to 35% of these carrying a primary diagnosis of HF.2 Recent data from several large registries of HF hospitalizations have demonstrated in-hospital mortality as high as 4% to 7%.3,4 Contributing to this is a significant incidence of VTE among hospitalized patients with HF.5 In addition, VTE is associated with thromboembolic complications, which are associated with long-term sequelae including postthrombotic syndromes, venous stasis, venous ulcers, chronic thromboembolic pulmonary hypertension, and pulmonary embolism (PE).6–8 These conditions are often associated with edema and chronic pain, which can have a significant impact on mobility and quality of life. Recurrent VTE and PE are also common complications reported in as many as 30% of patients.9 Published information suggests that despite availability of effective therapy and existence of practice guidelines,10,11 there is a significant underutilization of VTE prophylaxis in hospitalized patients with HF.12–15 Analysis of the Acute Decompensated Heart Failure National Registry revealed that of 71 376 patients eligible for VTE prophylaxis only 21 847 (31%) received prophylactic regimen.16 An analysis of the PREMIER database showed that although 79% of 34 286 patients admitted with HF received an order for VTE prophylaxis, only 15.8% received recommended appropriate prophylactic regimen in terms of the type of medications, dose, and duration of therapy.17 These data clearly demonstrate the need for increased awareness of prevention of VTE in hospitalized patients with HF. Therefore, the purpose of this article …