Venous Thromboembolism (VTE) Incidence and VTE-Associated Survival among Olmsted County Residents of Local Nursing Homes

Abstract

Nursing home (NH) residency is an independent risk factor for venous thromboembolism (VTE), but the VTE burden within the NH population is uncertain. This study estimates VTE incidence and VTE-associated mortality among NH residents. We identified all NH residents in any NH in Olmsted County, Minnesota, United States, 1 October 1998 to 31 December 2005 and all first lifetime VTE among county residents to estimate VTE incidence while resident of local NHs (NHVTE), using Centers for Medicare and Medicaid Services Minimum Data Set and Rochester Epidemiology Project resources. We tested associations between NHVTE and age, sex and time since each NH admission using Poisson modelling. Additionally, we tested incident NHVTE as a potential predictor of survival using Cox proportional hazards, adjusting for age, sex and NH residency. Between 1 October 1998 and 31 December 2005, 3,465 Olmsted County residents with ≥1 admission to a local NH, contributed 4,762 NH stays. Of the 3,465 NH residents, 111 experienced incident NHVTE (2.3% of all eligible stays), for an overall rate of 3,653/100,000 NH person-years (NH-PY). VTE incidence was inversely associated with time since each NH admission, and was highest in the first 7 days after each NH admission (18,764/100,000 NH-PY). The adjusted hazard of death for incident NHVTE was 1.90 (95% confidence interval [CI]: 1.38-2.62). In conclusion, VTE incidence among NH residents was nearly 30-fold higher than published incidence rates for the general Olmsted County population. VTE incidence was highest within 7 days after NH admission, and NHVTE was associated with significantly reduced survival. These data can inform future research and construction of clinical trials regarding short-term prophylaxis.

Reduced calf muscle pump function is a risk factor for venous thromboembolism: a population-based cohort study

“…The process for verification of VTE events in the REP has previously been described. 11,[13][14][15][16] Incident DVT events occurring in Olmsted County, Minnesota residents were objectively diagnosed by compression venous duplex ultrasonography, impedance plethysmography, computed tomographic venography, magnetic resonance imaging, venography, or pathology examination of thrombus removed at surgery or autopsy and were confirmed by study-trained registered nurses. PE within a segmental or larger artery was objectively diagnosed by a ventilation/perfusion lung scan interpreted as high probability for PE, computed tomographic pulmonary angiography, magnetic resonance imaging, pulmonary angiography, or pathology examination of thrombus at surgery or autopsy.…”

Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients: An NATF Anticoagulation Action Initiative

“…2 Some patients will be discharged to nursing home care, where VTE rates are up to 30fold higher than in the general population and highest in the initial 7 days of admission. 3 In the United States, approximately 200,000 VTE events occur annually following discharge. 4 There is currently a disconnect among guideline recommendations, clinical trial data, and clinical practice.…”

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

“…In particular, Apenteng et al ’s prospective cohort study demonstrated that in the same population, the incidence of VTE was obviously higher in long-term bedridden people than in old people who were able to act on their own in care homes ( 17 ). Petterson et al showed that nursing home residents had a substantially increased risk and the highest VTE incidence within 7 days after admission ( 18 ). Several similar reports have supported this view ( 20 , 21 ).…”