Key result
Incident hospitalized heart failure is linked to ~3.1-fold higher long-term VTE risk.
Why the study?
Although HF hospitalization increases short-term VTE risk, the long-term VTE risk associated with incident HF, HF subtypes, or structural heart disease was unknown.
Does incident hospitalized heart failure (including HFpEF and HFrEF) or echocardiographic left ventricular remodeling increase the long-term risk of incident venous thromboembolism in a community-based cohort?
Cohort (n=13,728)
Yes
Does incident hospitalized heart failure (including HFpEF and HFrEF) or echocardiographic left ventricular remodeling increase the long-term risk of incident venous thromboembolism in a community-based cohort?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“When patients come in decompensated with heart failure, they’ve been immobilized, they have acute systemic inflammation going on, there’s all these factors at play.... Because we had such a nice long data set to look at this, we’re able to tease out the true risk factor of heart failure itself, even after removing that hospitalization and removing those recurrent hospitalizations.”
“HF with either reduced or preserved EF carries a significantly higher risk for VTE. Furthermore, patients with echocardiographic findings conferring increased risk of developing HF also carry a higher risk of VTE, suggesting a prothrombotic state is an early development in the pathway to symptomatic HF. The ARIC analysis was limited by the requirement for hospitalization for both HF and VTE diagnosis. The true VTE rate may be somewhat higher than reported.”
“I predict that we will screen heart failure patients routinely for the dozens of candidate genes that predict a proclivity toward thrombosis.”
Incident hospitalized heart failure (both HFpEF and HFrEF) and echocardiographic indicators of left ventricular wall thickness are independently associated with a substantially increased long-term risk of venous thromboembolism.
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.
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Fanola et al. (2020) conducted a cohort in Incident Heart Failure (n=13,728). Incident hospitalized heart failure vs. No incident heart failure was evaluated on Incident venous thromboembolism (deep venous thrombosis or pulmonary embolism) (HR 3.13, 95% CI 2.58-3.80). Incident hospitalized heart failure was associated with a 3-fold increased long-term risk of venous thromboembolism compared with no heart failure (adjusted HR 3.13, 95% CI 2.58-3.80).
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