There have been marked changes in patient profiles as well as diagnosis and management of venous thromboembolism (VTE) in the last decade. The purpose of this study was to describe the demographic, clinical, and outcome characteristics of a community sample of patients diagnosed with VTE in 1999. Our findings are compared to those reported by the Worcester DVT study of 1988-1989.
The medical records of all residents from Worcester, MA (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible VTE at 11 Worcester hospitals in 1999 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. The distribution of clinical and treatment characteristics were compared, where possible, in a descriptive fashion to variables previously reported by the Worcester DVT study.
A total of 587 cases have been validated as VTE events for the year 1999. We present an interim analysis based on data from the first 392 cases enrolled. Please see Table 1.
The landscape of VTE has changed significantly over the last decade. Patients are older, have a different profile of risk factors, are more likely to be diagnosed using non-invasive modalities, and are less likely to be treated with IV heparin. VTE remains a disease of the outpatient with the majority of patients presenting to the hospital already with signs and symptoms of VTE. A substantial proportion of these patients had been hospitalized in the past 3 months. Hosptial associated mortality has declined over time but given decreased length of stay, further study of outpatient survival is needed.
Much of our understanding of the epidemiology of VTE is based on patients enrolled in observational studies more than a decade ago. Data from the ongoing Worcester VTE study will provide insights into changing patient profiles, utilization patterns of diagnostic and treatment modalities, and subsequent outcomes. These insights will, in turn, allow clinicians to optimize the care of these high-risk patients.
Characteristics of Patients with VTE: The Worcester Venous Thromboembolism StudyVariableWorcester DVT Study 1988-9 N=1231Worcester VTE Study 1999 N=392Mean Age (yr)6562Female (%)5453Risk Factors (%)*Recent Surgery1835Recent Prior Hospitalization5540Malignancy2230Recent ICU DischargeN/A17Recent IntubationN/A17Recent Fracture1016Congestive Heart Failure815Prior VTE2619Setting of VTE OccurrenceHospital Acquired1924Community Acquired8176DVT Diagnostic Tests (%)US4689Venogram531IPG510PE Diagnostic Tests (%)VQ8259Pulm Angiogram103Spiral CT04Initial Therapy (%)IV heparin9168SQ Enoxaparin024Other98Length of Stay (mean, d)1510Hospital Outcomes (%)Major Bleeding67Recurrent VTE21Mortality8.64*
Recent defined as < 6 months in initial Worcester DVT Study, < 3 months in.
Frederick Spencer, None.