Incident Heart Failure and Long-Term Risk for Venous Thromboembolism

Christina L. Fanola, Faye L. Norby, Amil M. Shah, Patricia P. Chang, Pamela L. Lutsey, Wayne D. Rosamond, Mary Cushman, Aaron R. Folsom

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)148-158
Number of pages11
JournalJournal of the American College of Cardiology
Issue number2
StatePublished - Jan 21 2020

Bibliographical note

Funding Information:
The authors thank the staff members and participants of the ARIC study for their important contributions. The National Heart, Lung, and Blood Institute provided support for venous thromboembolism identification (R01 HL059367) and for the ARIC study (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I). The work for this paper was also supported by National Heart, Lung, and Blood Institute grants K08HL116792, R01HL135008, and R01HL143224 (to Dr. Shah). Roche Diagnostics provided funding and laboratory reagents for the N-terminal pro-brain natriuretic peptide and TnT assays. Dr. Fanola has received consulting fees from Bristol-Myers Squibb, Johnson and Johnson, Janssen, and Inari Medical. Dr. Shah has received research support from Novartis; and has received consulting fees from Philips Ultrasound and Bellerophon. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2020 American College of Cardiology Foundation


  • deep venous thrombosis
  • echocardiography
  • heart failure
  • pulmonary embolism
  • venous thromboembolism


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