Increased Long-Term Risk for Venous Thromboembolism After Heart Failure – The Cardiology Advisor

The long-term risk for a venous thromboembolism (VTE) event was found to be associated with the occurrence of heart failure with preserved or reduced ejection fraction, and with left ventricular remodeling, according to a study published in the Journal of the American College of Cardiology.

In this prospective, population-based study, the short- and long-term risk for a VTE event was assessed in patients enrolled in the Atherosclerosis Risk in Communities study. Black or white patients aged 45 to 64 years were enrolled between 1987 and 1989. Follow-up data on the occurrence of heart failure hospitalization, the subtype of heart failure, and abnormal echocardiographic measurements were collected through 2015. A heart failure classification was based on signs and symptoms using Gothenburg criteria and/or the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for heart failure at discharge. Heart failure was then classified as either heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, or heart failure of undetermined classification. A venous thromboembolism event was validated using image testing and was then verified by 2 physicians. Follow-up appointments occurring after 2011 included a standardized echocardiographic examinationr.

Incident heart failure occurred in 2696 of 13,728 participants (19.6%). Patients who experienced heart failure were more frequently older black men with comorbidities such as hypertension, diabetes, and/or coronary artery disease. After a mean follow-up of 22 years, 729 VTE events occurred. Patients with vs without heart failure were at a 3 times higher risk for a VTE event (adjusted hazard ratio [aHR], 3.13; 95% CI, 2.58-3.80). The risk for a VTE event was greater in black vs white patients with heart failure (P =.0005).

Of the 7588 participants who were followed long-term , 1005 had an incident of heart failure. Of the patients with heart failure, 27.7% had heart failure with preserved ejection fraction, 27.4% had heart failure with reduced ejection fraction, and 45.0% had heart failure of undetermined classification. When compared with patients without heart failure, the risk for a VTE event was increased in patients with heart failure with preserved ejection fraction (aHR, 4.71; 95% CI, 2.94-7.52), in patients with heart failure with reduced ejection fraction (aHR, 5.53; 95% CI, 3.42-8.94), and in patients with heart failure of undetermined classification (aHR, 4.09; 95% CI, 2.60-6.44).

Of the 5438 patients without heart failure who had echocardiographic measurements, 86 experienced a VTE event. Left ventricular relative wall thickness (aHR, 1.25; 95% CI, 1.09-1.44; P =.002) and mean left ventricular wall thickness (aHR, 1.32; 95% CI, 1.10-1.59; P =.003) were identified as independent predictors of a VTE event in the absence of baseline heart failure.

Study limitations include the use of ICD-9-CM codes to assess heart failure, which could lead to misclassification, the lack of data on outpatient VTE eventa, the low number of VTE events in the echocardiographic measurement analysis, which limited statistical testing, and the lack of data on VTE mortality.

Patients who have been hospitalized with [heart failure] and either reduced or preserved [left ventricle] ejection or even with echocardiographic features of ventricular remodeling face an increased risk for developing VTE that persists through several decades of follow-up, concluded the study authors.

Disclosure: This clinical trial was supported by Roche Diagnostics. Several study authors declared affiliations with the pharmaceutical industry. Please see the reference for complete disclosure information.

Reference

Fanola CL, Norby FL, Shah AM, et al. Incident heart failure and long-term risk for venous thromboembolism. J Am Coll Cardiol. 2020;75(2):148-158.

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Increased Long-Term Risk for Venous Thromboembolism After Heart Failure - The Cardiology Advisor