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Declining National Annual IVC Filter Utilization: An Analysis on the Impact of Societal and Governmental Communications FREE TO VIEW

Osman Ahmed, MD; Ketan Patel, MD, FCCP; Mikin V. Patel, MD; Amanjit S. Baadh, MD; Sreekumar Madassery, MD; Ulku Cenk Turba, MD; Thomas J. Ward, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: A. S. B. is a speaker and advisory board member for Penumbra and Medtronic/Covidien and speaker for Cook, W.L. Gore, Guerbet, and CR Bard. O. A. is a speaker for Cook and shareholder of Penumbra. None declared (K. P., M. V. P., S. M., U. C. T., T. J. W.).

aDepartment of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL

bDepartment of Radiology, University of Chicago Medicine, Chicago, IL

cDepartment of Radiology, Section of Interventional Radiology, University of Central Florida College of Medicine, Florida Hospital, Orlando, FL

CORRESPONDENCE TO: Osman Ahmed, MD, Rush University Medical Center, 1725 W Harrison St, Ste 450, Chicago, IL 60612


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(6):1402-1404. doi:10.1016/j.chest.2017.03.038
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Until recently, the annual rate of inferior vena cava (IVC) filter placements has been increasing. The potential inappropriate utilization of IVC filters and its negative consequences have been discussed and highlighted by a US Food and Drug Administration (FDA)-issued advisory in 2010. We analyzed national annual IVC filter placement trends over the past 2 decades to assess for differences in placement rates following updates to societal guidelines, legal events, and governmental communications.

Hospital discharges from 1993 through 2014 were retrospectively analyzed using data from the Healthcare Cost and Utilization Project - National Inpatient Sample; yearly percentage change of filter placements were graphed and plotted with release dates for societal guidelines, legal events, and governmental communications issued over this time span. Legal events included the consolidation of IVC filter lawsuits into multidistrict litigations against C.R. Bard and Cook Medical., An inflection point from positive to negative use was identified in 2010, correlating with the year in which the FDA advisory was released.

We found that, from 1993 to 2010, the number of annual IVC filters placed increased from 28,330 to 129,614 (358% increase) at a compounded annual increase of 9.4% and maximum single-year increase of 25.8% (range, 1.7% to 25.8%). Filter use increased following societal guideline updates from the Eastern Association for the Surgery of Trauma in 2002, Society of Interventional Radiology in 2006, and American College of Clinical Pharmacy (ACCP) in 2008. After peaking in 2010, however, annual filter use declined to 96,005 in 2014, a -25.9% decline or 6.7% compounded yearly decrease (range, -5.4% to -9.3%) (Fig 1). This occurred despite stable and increased rates of DVT and pulmonary embolism diagnosed in this period. The FDA advisory regarding filter use in 2010, updates to American Heart Association in 2011 and ACCP in 2012 societal guidelines, and the consolidation of IVC filter lawsuits into multidistrict litigations in 2014 occurred during this period. Interrupted time series analysis of filter placements demonstrated a significant difference in trends between the pre-2010 and post-2010 periods (P = .0002) that were significant across subgroups of age, gender, and other studied variables. Decreased use was observed across all geographic regions of the United States (Table 1).

Figure Jump LinkFigure 1 Number of IVC filters placed per year.*Consolidation of IVC filter lawsuits into MDLs against C. R. Bard and Cook Medical by the US Judicial Panel on Multidistrict Litigation. ACCP = American College of Clinical Pharmacy; AHA = American Heart Association; EAST = Eastern Association for the Surgery of Trauma; FDA = Food and Drug Administration; IVC = inferior vena cava; MDL = multidistrict litigation.Grahic Jump Location

Table Graphic Jump Location
Table 1 Geographic Rates of IVC Filters Placements, PE, DVT, and IVC Filters per 100 DVTs/PEs

IVC = inferior vena cava; PE = pulmonary embolism.

Since 2010, annual IVC filter use has declined by compound and overall rates of -6.7% and -25.9%, respectively. In evaluating the events that occurred since 2010, it remains likely that the FDA advisory, incorporation of legal cases into multidistrict litigations, and updated American Heart Association and ACCP guidelines recommending only therapeutic placements have contributed to temper the number of filters placed annually in the United States.

References

Antevil J.L. .Sise M.J. .Sack D.I. .et al Retrievable vena cava filters for preventing pulmonary embolism in trauma patients: a cautionary tale. J Trauma. 2006;60:35-40 [PubMed]journal. [PubMed]
 
IN RE COOK MEDICAL, INC., IVC FILTERS MARKETING, 53F.Supp.3d (J.P.M.L 2014).
 
IN RE BARD IVC FILTERS PRODUCTS LIBABILITY LITIGATION (J.P.M.L 2015).
 

Figures

Figure Jump LinkFigure 1 Number of IVC filters placed per year.*Consolidation of IVC filter lawsuits into MDLs against C. R. Bard and Cook Medical by the US Judicial Panel on Multidistrict Litigation. ACCP = American College of Clinical Pharmacy; AHA = American Heart Association; EAST = Eastern Association for the Surgery of Trauma; FDA = Food and Drug Administration; IVC = inferior vena cava; MDL = multidistrict litigation.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 Geographic Rates of IVC Filters Placements, PE, DVT, and IVC Filters per 100 DVTs/PEs

IVC = inferior vena cava; PE = pulmonary embolism.

References

Antevil J.L. .Sise M.J. .Sack D.I. .et al Retrievable vena cava filters for preventing pulmonary embolism in trauma patients: a cautionary tale. J Trauma. 2006;60:35-40 [PubMed]journal. [PubMed]
 
IN RE COOK MEDICAL, INC., IVC FILTERS MARKETING, 53F.Supp.3d (J.P.M.L 2014).
 
IN RE BARD IVC FILTERS PRODUCTS LIBABILITY LITIGATION (J.P.M.L 2015).
 
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