Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care Database
Background Pulmonary hypertension (PH) is a devastating potential complication of pulmonary embolism, a manifestation of venous thromboembolism (VTE). The incidence of and risk factors for PH in those with prior VTE are poorly characterized. Methods and Results International Classification of Diseas...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024358 |
| _version_ | 1797936071715061760 |
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| author | Pamela L. Lutsey Line H. Evensen Thenappan Thenappan Kurt W. Prins Rob F. Walker Joel F. Farley Richard F. MacLehose Alvaro Alonso Neil A. Zakai |
| author_facet | Pamela L. Lutsey Line H. Evensen Thenappan Thenappan Kurt W. Prins Rob F. Walker Joel F. Farley Richard F. MacLehose Alvaro Alonso Neil A. Zakai |
| author_sort | Pamela L. Lutsey |
| collection | DOAJ |
| description | Background Pulmonary hypertension (PH) is a devastating potential complication of pulmonary embolism, a manifestation of venous thromboembolism (VTE). The incidence of and risk factors for PH in those with prior VTE are poorly characterized. Methods and Results International Classification of Diseases (ICD) codes from inpatient and outpatient medical claims from MarketScan administrative databases for years 2011 to 2018 were used to identify cases of VTE, comorbidities before the VTE event, and PH occurring subsequent to the VTE event. Cumulative incidence and hazard ratios (HR), and their 95% CI, were calculated. The 170 021 VTE cases included in the analysis were on average (±SD) 57.5±15.8 years old and 50.5% were female. A total of 5943 PH cases accrued over an average follow‐up of 1.94 years. Two years after incident VTE, the cumulative incidence (95% CI) of PH was 3.5% (3.4%–3.7%) overall. It was higher among older individuals, among women (3.9% [3.8%–4.1%]) than men (3.2% [3.0%–3.3%]), and among patients presenting with pulmonary embolism (6.2% [6.0%–6.5%]) than those presenting with deep vein thrombosis only (1.1% [1.0%–1.2%]). Adjusting for age and sex, risk of PH was higher among patients with VTE with underlying comorbidities. Using the Charlson comorbidity index, there was a dose–response relationship, whereby greater scores were associated with increased PH risk (score ≥5 versus 0: HR, (2.50 [2.30–2.71])). When evaluating individual comorbidities, the strongest associations were observed with concomitant heart failure (HR, 2.17 [2.04–2.31]), chronic pulmonary disease (2.01 [1.90–2.14]), and alcohol abuse (1.66 [1.29–2.13]). Conclusions In this large, real‐world population of insured people with VTE, 3.5% developed PH in the 2 years following their initial VTE event. Risk was higher among women, with increasing age, and in those with additional comorbidities at the time of the VTE event. These data provide insights into the burden of PH and risk factors for PH among patients with VTE. |
| first_indexed | 2024-04-10T18:25:04Z |
| format | Article |
| id | doaj.art-ee6b78bab45543bcac7ae76fcf308c3f |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T18:25:04Z |
| publishDate | 2022-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ee6b78bab45543bcac7ae76fcf308c3f2023-02-02T06:20:21ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-07-01111410.1161/JAHA.121.024358Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care DatabasePamela L. Lutsey0Line H. Evensen1Thenappan Thenappan2Kurt W. Prins3Rob F. Walker4Joel F. Farley5Richard F. MacLehose6Alvaro Alonso7Neil A. Zakai8Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MNK.G. Jebsen ‐ Thrombosis Research and Expertise Center (TREC) Department of Clinical Medicine UiT The Arctic University of Norway Tromsø NorwayDivision of Cardiovascular Sciences School of Medicine University of Minnesota Minneapolis MNDivision of Cardiovascular Sciences School of Medicine University of Minnesota Minneapolis MNDivision of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MNDepartment of Pharmaceutical Care and Health Systems College of Pharmacy University of Minnesota Minneapolis MNDivision of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MNDepartment of Epidemiology Rollins School of Public Health Emory University Atlanta GADivision of Hematology/Oncology Department of Medicine & Department of Pathology and Laboratory Medicine Larner College of Medicine University of Vermont Burlington VTBackground Pulmonary hypertension (PH) is a devastating potential complication of pulmonary embolism, a manifestation of venous thromboembolism (VTE). The incidence of and risk factors for PH in those with prior VTE are poorly characterized. Methods and Results International Classification of Diseases (ICD) codes from inpatient and outpatient medical claims from MarketScan administrative databases for years 2011 to 2018 were used to identify cases of VTE, comorbidities before the VTE event, and PH occurring subsequent to the VTE event. Cumulative incidence and hazard ratios (HR), and their 95% CI, were calculated. The 170 021 VTE cases included in the analysis were on average (±SD) 57.5±15.8 years old and 50.5% were female. A total of 5943 PH cases accrued over an average follow‐up of 1.94 years. Two years after incident VTE, the cumulative incidence (95% CI) of PH was 3.5% (3.4%–3.7%) overall. It was higher among older individuals, among women (3.9% [3.8%–4.1%]) than men (3.2% [3.0%–3.3%]), and among patients presenting with pulmonary embolism (6.2% [6.0%–6.5%]) than those presenting with deep vein thrombosis only (1.1% [1.0%–1.2%]). Adjusting for age and sex, risk of PH was higher among patients with VTE with underlying comorbidities. Using the Charlson comorbidity index, there was a dose–response relationship, whereby greater scores were associated with increased PH risk (score ≥5 versus 0: HR, (2.50 [2.30–2.71])). When evaluating individual comorbidities, the strongest associations were observed with concomitant heart failure (HR, 2.17 [2.04–2.31]), chronic pulmonary disease (2.01 [1.90–2.14]), and alcohol abuse (1.66 [1.29–2.13]). Conclusions In this large, real‐world population of insured people with VTE, 3.5% developed PH in the 2 years following their initial VTE event. Risk was higher among women, with increasing age, and in those with additional comorbidities at the time of the VTE event. These data provide insights into the burden of PH and risk factors for PH among patients with VTE.https://www.ahajournals.org/doi/10.1161/JAHA.121.024358epidemiologypulmonary hypertensionvenous thromboembolism |
| spellingShingle | Pamela L. Lutsey Line H. Evensen Thenappan Thenappan Kurt W. Prins Rob F. Walker Joel F. Farley Richard F. MacLehose Alvaro Alonso Neil A. Zakai Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care Database Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease epidemiology pulmonary hypertension venous thromboembolism |
| title | Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care Database |
| title_full | Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care Database |
| title_fullStr | Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care Database |
| title_full_unstemmed | Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care Database |
| title_short | Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care Database |
| title_sort | incidence and risk factors of pulmonary hypertension after venous thromboembolism an analysis of a large health care database |
| topic | epidemiology pulmonary hypertension venous thromboembolism |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024358 |
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