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Incident heart failure tied to increased long-term risk for VTE

Incident heart failure tied to increased long-term risk for venous thromboembolism

Findings suggest the need for evidence-based strategies to prevent long-term venous thromboembolism in these patients beyond hospitalisation time.

Main Takeaway

  • Incident heart failure (HF) hospitalisation was associated with more than a 3-fold higher risk for venous thromboembolism (VTE) which persisted through a long-term follow-up.
  • The increased risk for VTE persisted in participants with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).
  • In participants without clinical HF, left ventricular (LV) relative wall thickness and mean wall thickness were predictors of VTE.

Why This Matters

  • HF not only increases the risk for cardioembolic events and ischaemic stroke but also increases the risk for VTE.
  • Hospitalised patients for acute HF are at an increased risk for short-term VTE due to prolonged immobilisation and hypercoagulability

Study Design

  • This prospective population-based study included 13,728 participants from the Atherosclerosis Risk In Communities (ARIC) cohort.
  • Patients with (mean age, 56.1 years) and without (mean age, 53.5 years) incident HF hospitalisation were included.
  • Short- and long-term VTE risks associated with:
    • incident HF during 1987-2015 (n=13,728; design 1);
    • HF subtype during 2005-2015 (n=7588; design 2); and
    • abnormal echocardiographic measures in the absence of clinical HF during 2011-2015 (n=5438; design 3) were assessed.
  • Funding: ARIC cohort was funded by the National Heart, Lung, and Blood Institute.

Key Results

  • Incident HF occurred in 19.6% of patients included in the design1.
  • During a mean follow-up of 22±7 years, incident HF vs no HF was associated with an increased risk for incident total VTE (adjusted HR [aHR], 3.13; 95% CI, 2.58-3.80).
  • Incident HF vs no HF was associated with a 2-fold greater risk for all VTE subtypes:
    • Pulmonary embolism: aHR, 2.57; 95% CI, 1.95-3.39;
    • Deep venous thrombosis: aHR, 3.90; 95% CI, 2.96-5.13;
    • Provoked VTE events: aHR, 2.26; 95% CI, 1.60-3.19; and
    • Unprovoked VTE events: aHR, 3.72; 95% CI, 2.94-4.72.
  • Incident HF occurred in 15.3% of participants allocated to the design2.
  • Over a mean follow-up of 9.7±2.6 years, VTE rates in those with vs without HF were 21.8 (95% CI, 16.9-27.6) vs 3.04 (95% CI, 2.64-3.49) per 1000 person-years.
  • Compared with no HF, VTE risk was reported in:
    • Any HF: aHR, 5.15; 95% CI, 3.80-6.98;
    • HFpEF: aHR, 4.71; 95% CI, 2.94-7.52;
    • HFrEF: aHR, 5.53; 95% CI, 3.42-8.94; and
    • Undetermined incident HF: aHR, 4.09; 95% CI, 2.60-6.44.
  • In participants allocated to the design 3, 86 incident VTE events were reported over a mean follow-up of 3.5±0.7 years.
  • In the absence of baseline HF, LV relative wall thickness (P=0.002) and mean LV wall thickness (P=0.003) were found to be predictors of incident VTE after additional adjustment for chronic kidney disease and atrial fibrillation

Limitations

  • ARIC-based incident HF on hospitalisations.
  • VTE validation failed to capture outpatient VTE.
  • The number of VTE events for design 3 was small.
  • The observed association between HF and VTE may not be causal.
  • Incident VTE-related mortality was not assessed.

Reference

  1. Fanola CL, Norby FL, Shah AM, Chang PP, Lutsey PL, Rosamond WD, Cushman M, Folsom AR. Incident Heart Failure and Long-Term Risk for Venous Thromboembolism. J Am Coll Cardiol. 2020;75(2):148-158. doi: 10.1016/j.jacc.2019.10.058. PMID: 31948643.
MAT-BH-2100641/v2/Jun 2023