Long-term risk for VTE significant after HF hospitalization
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Patients hospitalized for HF were found to have significantly elevated long-term risk for venous thromboembolism, regardless of ejection fraction.
In addition, in individuals without HF, indicators of left ventricular remodeling conferred elevated risk for VTE, researchers reported.
Analyzing a group of 13,728 participants from the ARIC cohort who were followed for 22 years, researchers observed that HF was associated with a significantly increased long-term risk for VTE (adjusted HR = 3.13; 95% CI, 2.58-3.8), according to findings published in the Journal of the American College of Cardiology.
Moreover, in 7,588 participants followed up for a mean of 10 years, the risk for VTE was similar for both HF with preserved ejection fraction (aHR = 4.71; 95% CI, 2.94-7.52) and reduced ejection fraction (aHR = 5.53; 95% CI, 3.42-8.94).
“To our knowledge, this ARIC cohort report is the first long-term longitudinal prospective analysis of incident HF as a risk factor for incident VTE,” Christina L. Fanola, MD, MSC, assistant professor of medicine in the cardiovascular division at the University of Minnesota, and colleagues wrote. “Our findings demonstrated that incident HF hospitalization was associated with both short-term and long-term risk for VTE, independent of multiple VTE risk factors. The increased VTE risk emerged shortly after incident HF hospitalization, as might be expected, but was present even after removal of early hospital-related VTE events and adjustment for the number of subsequent hospitalizations.”
VTE risk and HF subtypes
In other findings, among 5,438 participants without HF who received echocardiography at their fifth clinical examination and were followed for a mean of 3.5 years, LV relative wall thickness and mean LV wall thickness were found to be independent predictors of VTE, according to the study.
“Even in those without clinical HF, early changes in LV wall thickness and concentricity detected by echocardiography were predictive of incident VTE,” the researchers wrote. “The consistency and strength of the associations across our three designs [HF hospitalization, HF subtype and structural heart disease] may suggest a causal relation between HF and VTE.”
Using data from the ARIC cohort of patients with HF hospitalization (n = 2,696; mean age, 56 years; 50% men; 33% black; 23% with diabetes) and without (n = 11,032; mean age, 54 years; 45% men; 24% black; 8% with diabetes), researchers aimed to assess the long-term risk for VTE associated with incident HF, HF subtypes or structural heart disease.
Editorial comment
“Heart failure has been recognized previously as a ‘minor persistent risk factor’ for ‘provoked’ VTE,” Samuel Z. Goldhaber, MD, professor of medicine at Harvard Medical School and director of the VTE research group at Brigham and Women's Hospital, wrote in a related editorial. “However, dogma rather than data dismissed heart failure as a long-term risk factor for recurrent VTE.
“The ARIC investigators should continue to pursue prospective study of the heart failure/VTE connection,” Goldhaber wrote. “There is a myriad of opportunities going forward, including substudies using magnetic resonance imaging, extensive genetic screening and artificial intelligence to sort and analyze the vast volume of epidemiological data that are collected.” – by Scott Buzby
Disclosures: Fanola reports she received consultant fees from Bristol-Myers Squibb, Inari Medical, Janssen and Johnson & Johnson. Goldhaber reports he received research support from Bayer, Boehringer Ingelheim, Boston Scientific’s BTG EKOS, Bristol-Myers Squibb, Daiichi-Sankyo, Janssen and the NHLBI; and has served as a consultant for Bayer and Boehringer Ingelheim. Please see the study for all other authors’ relevant financial disclosures.
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