Christina L Fanola1, Faye L Norby2, Amil M Shah3, Patricia P Chang4, Pamela L Lutsey2, Wayne D Rosamond4, Mary Cushman5, Aaron R Folsom2. 1. Division of Cardiovascular Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota. Electronic address: cfanola@umn.edu. 2. Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota. 3. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 4. Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina. 5. Departments of Medicine and Pathology, University of Vermont Medical Center, Burlington, Vermont.
Abstract
BACKGROUND: Heart failure (HF) hospitalization places patients at increased short-term risk for venous thromboembolism (VTE). Long-term risk for VTE associated with incident HF, HF subtypes, or structural heart disease is unknown. OBJECTIVES: In the ARIC (Atherosclerosis Risk In Communities) cohort, VTE risk associated with incident HF, HF subtypes, and abnormal echocardiographic measures in the absence of clinical HF was assessed. METHODS: During follow-up, ARIC identified incident HF and subcategorized HF with preserved ejection fraction or reduced ejection fraction. At the fifth clinical examination, echocardiography was performed. Physicians adjudicated incident VTE using hospital records. Adjusted Cox proportional hazards models were used to evaluate the association between HF or echocardiographic exposures and VTE. RESULTS: Over a mean of 22 years in 13,728 subjects, of whom 2,696 (20%) developed incident HF, 729 subsequent VTE events were identified. HF was associated with increased long-term risk for VTE (adjusted hazard ratio: 3.13; 95% confidence interval: 2.58 to 3.80). In 7,588 subjects followed for a mean of 10 years, the risk for VTE was similar for HF with preserved ejection fraction (adjusted hazard ratio: 4.71; 95% CI: 2.94 to 7.52) and HF with reduced ejection fraction (adjusted hazard ratio: 5.53; 95% confidence interval: 3.42 to 8.94). In 5,438 subjects without HF followed for a mean of 3.5 years, left ventricular relative wall thickness and mean left ventricular wall thickness were independent predictors of VTE. CONCLUSIONS: In this prospective population-based study, incident hospitalized HF (including both heart failure with preserved ejection fraction and reduced ejection fraction), as well as echocardiographic indicators of left ventricular remodeling, were associated with greatly increased risk for VTE, which persisted through long-term follow-up. Evidence-based strategies to prevent long-term VTE in patients with HF, beyond time of hospitalization, are needed.
BACKGROUND:Heart failure (HF) hospitalization places patients at increased short-term risk for venous thromboembolism (VTE). Long-term risk for VTE associated with incident HF, HF subtypes, or structural heart disease is unknown. OBJECTIVES: In the ARIC (Atherosclerosis Risk In Communities) cohort, VTE risk associated with incident HF, HF subtypes, and abnormal echocardiographic measures in the absence of clinical HF was assessed. METHODS: During follow-up, ARIC identified incident HF and subcategorized HF with preserved ejection fraction or reduced ejection fraction. At the fifth clinical examination, echocardiography was performed. Physicians adjudicated incident VTE using hospital records. Adjusted Cox proportional hazards models were used to evaluate the association between HF or echocardiographic exposures and VTE. RESULTS: Over a mean of 22 years in 13,728 subjects, of whom 2,696 (20%) developed incident HF, 729 subsequent VTE events were identified. HF was associated with increased long-term risk for VTE (adjusted hazard ratio: 3.13; 95% confidence interval: 2.58 to 3.80). In 7,588 subjects followed for a mean of 10 years, the risk for VTE was similar for HF with preserved ejection fraction (adjusted hazard ratio: 4.71; 95% CI: 2.94 to 7.52) and HF with reduced ejection fraction (adjusted hazard ratio: 5.53; 95% confidence interval: 3.42 to 8.94). In 5,438 subjects without HF followed for a mean of 3.5 years, left ventricular relative wall thickness and mean left ventricular wall thickness were independent predictors of VTE. CONCLUSIONS: In this prospective population-based study, incident hospitalized HF (including both heart failure with preserved ejection fraction and reduced ejection fraction), as well as echocardiographic indicators of left ventricular remodeling, were associated with greatly increased risk for VTE, which persisted through long-term follow-up. Evidence-based strategies to prevent long-term VTE in patients with HF, beyond time of hospitalization, are needed.
Authors: Susan R Kahn; Wendy Lim; Andrew S Dunn; Mary Cushman; Francesco Dentali; Elie A Akl; Deborah J Cook; Alex A Balekian; Russell C Klein; Hoang Le; Sam Schulman; M Hassan Murad Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: Margaret C Fang; Dongjie Fan; Sue Hee Sung; Daniel M Witt; Steven H Yale; Steven R Steinhubl; Alan S Go Journal: JAMA Intern Med Date: 2015-06 Impact factor: 21.873
Authors: Eduardo S Darze; Adriana L Latado; Aloyra G Guimarães; Rodrigo A V Guedes; Alessandra B Santos; Simone S de Moura; Luiz Carlos Santana Passos Journal: Chest Date: 2007-03-30 Impact factor: 9.410
Authors: Holger J Schünemann; Mary Cushman; Allison E Burnett; Susan R Kahn; Jan Beyer-Westendorf; Frederick A Spencer; Suely M Rezende; Neil A Zakai; Kenneth A Bauer; Francesco Dentali; Jill Lansing; Sara Balduzzi; Andrea Darzi; Gian Paolo Morgano; Ignacio Neumann; Robby Nieuwlaat; Juan J Yepes-Nuñez; Yuan Zhang; Wojtek Wiercioch Journal: Blood Adv Date: 2018-11-27
Authors: Faiez Zannad; Stefan D Anker; William M Byra; John G F Cleland; Min Fu; Mihai Gheorghiade; Carolyn S P Lam; Mandeep R Mehra; James D Neaton; Christopher C Nessel; Theodore E Spiro; Dirk J van Veldhuisen; Barry Greenberg Journal: N Engl J Med Date: 2018-08-27 Impact factor: 91.245
Authors: Laura R Loehr; Wayne D Rosamond; Patricia P Chang; Aaron R Folsom; Lloyd E Chambless Journal: Am J Cardiol Date: 2008-02-14 Impact factor: 2.778
Authors: J G F Cleland; I Findlay; S Jafri; G Sutton; R Falk; C Bulpitt; C Prentice; I Ford; Adele Trainer; P A Poole-Wilson Journal: Am Heart J Date: 2004-07 Impact factor: 4.749
Authors: Stephan von Haehling; Christoph Birner; Elke Dworatzek; Stefan Frantz; Kristian Hellenkamp; Carsten W Israel; Tibor Kempf; Hermann H Klein; Christoph Knosalla; Ulrich Laufs; Philip Raake; Rolf Wachter; Gerd Hasenfuss Journal: Nat Rev Cardiol Date: 2022-01-06 Impact factor: 49.421