VTE research by itself is hugely popular—as exemplified by the staggering number of nearly 130,000 hits in PubMed using search terms for VTE. Unfortunately, however, only an alarmingly low number of 79 of these articles study VTE in a nursing home setting. We, therefore, welcome the article by Leibson et al,1 as it clearly shows us that evidence (and, thus, also guidelines) from a non-nursing home setting cannot easily be transferred to nursing homes, given the differences in VTE risk factors as they described. In a recent publication from our group, we found similar issues regarding the difficulty of transferring evidence.2 In a sample of 423 nursing home residents with suspected VTE, 322 patients were at high risk based on a clinical decision rule combined with D-dimer testing. Of these patients, 126 (39%) were not referred for additional imaging, despite the fact that guidelines for non-nursing homes currently recommend doing so. We evaluated reasons for these nonreferral decisions as well as their consequences. Physicians reported that advance care planning and the estimated impact on life expectancy of concurrent comorbidity (including, thus, the relative merits of further diagnostic investigations) played a role in these nonreferral decisions. Nonreferral was associated with higher risk of mortality (crude OR, 2.45; 95% CI, 1.40-4.29), yet this OR no longer reached significance when adjusted for comorbidity (using propensity scores estimating the probability of referral).