Incidence and Risk Factors of Pulmonary Hypertension After Venous Thromboembolism: An Analysis of a Large Health Care Database

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

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Abstract

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.

Original languageEnglish (US)
Article numbere024358
JournalJournal of the American Heart Association
Volume11
Issue number14
DOIs
StatePublished - Jul 19 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01-HL131579, as well as K24 HL159246 (PLL), K24 HL148521 (AA) and K08 HL140100 (KWP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2022 The Authors.

Keywords

  • epidemiology
  • pulmonary hypertension
  • venous thromboembolism

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