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Original Research: Pulmonary Vascular Disease |

Rethinking Guidelines for VTE Risk Among Nursing Home ResidentsIdentifying VTE Risk Among Nursing Home Residents: A Population-Based Study Merging Medical Record Detail With Standardized Nursing Home Assessments

Cynthia L. Leibson, PhD; Tanya M. Petterson, MS; Carin Y. Smith, BS; Kent R. Bailey, PhD; Jane A. Emerson, RN; Aneel A. Ashrani, MD; Paul Y. Takahashi, MD; John A. Heit, MD
Author and Funding Information

From the Division of Epidemiology (Dr Leibson and Ms Emerson) and the Division of Biomedical Statistics and Informatics (Mss Petterson and Smith and Dr Bailey), Department of Health Sciences Research, and the Division of Hematology (Drs Ashrani and Heit), Division of Primary Care (Dr Takahashi), and Division of Cardiovascular Disease (Dr Heit), Department of Internal Medicine, Mayo Clinic, Rochester, MN.

CORRESPONDENCE TO: Cynthia L. Leibson, PhD, Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: leibson@mayo.edu


Parts of this study were presented at the American Society of Hematology 52nd Annual Meeting, December 4-7, 2010, Orlando, FL.

FUNDING/SUPPORT: This study was funded by National Institutes of Health [Grants R01AG 31027-4 and R01HL 66216-9]. Study data were obtained from the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health [Award number R01 AG034676].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):412-421. doi:10.1378/chest.13-2652
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BACKGROUND:  Nursing home (NH) residents are at increased risk for both VTE and bleeding from pharmacologic prophylaxis. Construction of prophylaxis guidelines is hampered by NH-specific limitations with VTE case identification and characterization of risk. We addressed these limitations by merging detailed provider-linked Rochester Epidemiology Project (REP) medical records with Centers for Medicare and Medicaid Services Minimum Data Set (MDS) NH assessments.

METHODS:  This population-based nested case-control study identified all Olmsted County, Minnesota, residents with first-lifetime VTE October 1, 1998, through December 31, 2005, while a resident of an NH (N = 91) and one to two age-, sex-, and calendar year-matched NH non-VTE control subjects. For each NH case without hospitalization 3 months before VTE (n = 23), we additionally identified three to four nonhospitalized NH control subjects. REP and MDS records were reviewed before index date (VTE date for cases; respective REP encounter date for control subjects) for numerous characteristics previously associated with VTE in non-NH populations. Data were modeled using conditional logistic regression.

RESULTS:  The multivariate model consisting of all cases and control subjects identified only three characteristics independently associated with VTE: respiratory infection vs no infection (OR, 5.9; 95% CI, 2.6-13.1), extensive or total assistance with walking in room (5.6, 2.5-12.6), and general surgery (3.3, 1.0-10.8). In analyses limited to nonhospitalized cases and control subjects, only nonrespiratory infection vs no infection was independently associated with VTE (8.8, 2.7-29.2).

CONCLUSIONS:  Contrary to previous assumptions, most VTE risk factors identified in non-NH populations do not apply to the NH population. NH residents with infection, substantial mobility limitations, or recent general surgery should be considered potential candidates for VTE prophylaxis.


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