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IVC filter use to prevent PE increases while mortality rates decline
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The use of inferior vena cava filters to prevent recurrent pulmonary embolism grew increasingly common in the United States during a 10-year period while mortality rates for pulmonary embolism decreased, according to results reported in the Journal of the American College of Cardiology.
The national cohort study included data from 556,658 Medicare beneficiaries aged 65 years and older with a principal diagnosis of pulmonary embolism (PE) between 1999 and 2010. The researchers calculated the rate of placement of inferior vena cava (IVC) filters and identified mortality rates in-hospital and at 30 days, 6 months and 1 year after placement.
Patients received IVC filters in 94,427 cases. The rate of placement in this population increased from 5,003 in 1999 to 8,928 in 2010, or from 19 per 100,000 beneficiary-years to 32.5 (P < .001 for both increases). The researchers noted that the number of PE-related hospitalizations rose each year, from 31,746 to 54,392; however, the rate of IVC filter placement did not increase within the overall population (157.6 per 1,000 hospitalizations in 1999 vs. 164.1 in 2010; P = .11).
Results from subgroup analyses indicated an increase in the placement rate among patients aged 85 years and older (150 per 1,000 patients vs. 194.6; P < .001). Placement was consistently more common among men than women. The researchers wrote that IVC filter placement was most common among blacks compared with other ethnic groups, but the placement rate decreased in this population between 1999 and 2010 (P < .05).
Frequency of IVC filter placement varied according to region, with the highest placement rate observed in the South Atlantic region and the lowest in the Mountain region. IVC filter placement became increasingly common in the West North Center and Mid-Atlantic regions between 1999 and 2010, but decreased in New England (P < .001).
Among all patients diagnosed with PE, mortality rates decreased during the evaluated period, both overall and in all evaluated subgroups. At 30 days, the adjusted mortality rate decreased from 12.7% in 1999 to 9% in 2010; the 12-month adjusted rate decreased from 26.3% to 22.4% (P < .001 for both). In patients who received IVC filters, in-hospital mortality decreased from 8.2% in 1999 to 4.3% in 2010, whereas 30-day mortality declined from 13.4% to 10.9%, 6-month mortality from 28.8% to 26.7%, and 12-month mortality from 33.4% to 30.6% from 1999 to 2010 (P .001 for all). The researchers also noted that men had higher mortality rates at 30 days and 1 year compared with women.
“We demonstrated frequent and increasing use of IVC [filters] in patients with PE over time,” the researchers concluded. “This occurred in the context of increasing PE hospitalizations and declining mortality rates in all patients with PE, including those who did and did not receive IVC [filters]. Collectively, our results suggest that more permissive use of technology has occurred over time in the setting of persistent controversy for net benefit.” – by Adam Taliercio
Disclosure: One researcher reports receiving research funding from Johnson & Johnson and Medtronic, and serving on a scientific advisory board for UnitedHealth. Two other researchers report serving on a scientific advisory board for UnitedHealth.
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