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Trends in Utilization of Inferior Vena Cava Filters and Predictors of Their Use in United States: A Nationwide Study From 2000 to 2009 FREE TO VIEW

Shahryar Ahmad; Awani Deshmukh; Amit Taneja; Saqib Baig; Gagan Kumar; Rahul Nanchal
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Medical College of Wisconsin, Milwaukee, WI

Chest. 2014;146(4_MeetingAbstracts):834A. doi:10.1378/chest.1995266
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The role of inferior vena cava (IVC) filters in pulmonary embolism is limited to those with contraindication to/complication of systemic anticoagulation or in those with recurrent pulmonary embolism despite adequate anticoagulation. A recent study in Medicare patients found that the use of IVC filters has been steadily increasing and most of them are not removed. We examined the trends of IVC filter placement in patients admitted with acute pulmonary embolism and identified factors associated with increased use of this procedure

METHODS: We used Nationwide Inpatient Sample (NIS) database from 2000 to 2009 for our study. Pulmonary embolism was identified using ICD-9-CM codes. The use of IVC filters during the admission was identified similarly. We used variance weighted least squares method to compare the trends. We constructed logistic multivariable regression model to examine the patients demographical and hospital characteristics associated with increased use of IVC filter

RESULTS: There were 1,313,021 discharges with primary diagnosis of pulmonary embolism. Of these, 177,472(13.5%) received IVC filter. The total number of IVC filters has increased from 10,818 in 2000 to 22,439 in 2009. However, the proportion of patients with pulmonary embolism receiving IVC filter increased from 2000(12.4%) to 2001(13.3%), but has remained statistically unchanged through 2001 to 2009(13.3%). The variables associated with increased use of IVC filters were - increasing age(OR 1.02;95%CI 1.02-1.02), male gender(OR 1.16;95%CI 1.14-1.19), hispanics(OR 1.25,95%CI 1.20-1.34), teaching hospitals(OR 1.16;95%CI 1.13-1.18). There was significantly lower use of IVC filter in uninsured when compared to private insurance(OR 0.87; 95%CI 0.81-0.94). The odds of use of IVC filter was also lower in Western(OR 0.52; 95%CI 0.50-0.54), Mid West(OR 0.70,95%CI 0.67-0.72) and Southern(OR 0.86;95%CI 0.83-0.89) regions of United States as compared to North Eastern region

CONCLUSIONS: We conclude that while the rate of IVC filter used in pulmonary embolism has remained unchanged from 2001 to 2009, the increased number of IVC filters placed is due to increasing incidence of pulmonary embolism. There are racial, economic and geographical variables which may dictate the use of IVC filters

CLINICAL IMPLICATIONS: There are significant racial, economic and geographical variation is use of IVC filters in United States which needs to be studied further

DISCLOSURE: The following authors have nothing to disclose: Shahryar Ahmad, Awani Deshmukh, Amit Taneja, Saqib Baig, Gagan Kumar, Rahul Nanchal

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