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Thromb Haemost 2018; 118(07): 1316-1328
DOI: 10.1055/s-0038-1660436
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Venous Thromboembolism (VTE) Incidence and VTE-Associated Survival among Olmsted County Residents of Local Nursing Homes

Tanya M. Petterson
1   Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Carin Y. Smith
1   Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Jane A. Emerson
2   Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Kent R. Bailey
1   Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Aneel A. Ashrani
3   Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
John A. Heit
2   Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
3   Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
4   Department of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Cynthia L. Leibson
2   Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
› Author Affiliations Funding This research was supported in part by National Institutes of Health grants from the National Institute on Aging to CLL (Award Number R01AG31027) and the National Heart Lung and Blood Institute to J.A.H. and to A.A.A. and K.R.B. (Award Number R01HL66216), and was made possible by the Rochester Epidemiology Project (National Institutes of Health, National Institute on Aging [Award Number R01AG034676]). Research support was also provided by the Mayo Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Publication History

27 March 2018

02 May 2018

Publication Date:
02 July 2018 (online)

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Abstract

Nursing home (NH) residency is an independent risk factor for venous thromboembolism (VTE), but the VTE burden within the NH population is uncertain. This study estimates VTE incidence and VTE-associated mortality among NH residents. We identified all NH residents in any NH in Olmsted County, Minnesota, United States, 1 October 1998 to 31 December 2005 and all first lifetime VTE among county residents to estimate VTE incidence while resident of local NHs (NHVTE), using Centers for Medicare and Medicaid Services Minimum Data Set and Rochester Epidemiology Project resources. We tested associations between NHVTE and age, sex and time since each NH admission using Poisson modelling. Additionally, we tested incident NHVTE as a potential predictor of survival using Cox proportional hazards, adjusting for age, sex and NH residency. Between 1 October 1998 and 31 December 2005, 3,465 Olmsted County residents with ≥1 admission to a local NH, contributed 4,762 NH stays. Of the 3,465 NH residents, 111 experienced incident NHVTE (2.3% of all eligible stays), for an overall rate of 3,653/100,000 NH person-years (NH-PY). VTE incidence was inversely associated with time since each NH admission, and was highest in the first 7 days after each NH admission (18,764/100,000 NH-PY). The adjusted hazard of death for incident NHVTE was 1.90 (95% confidence interval [CI]: 1.38–2.62). In conclusion, VTE incidence among NH residents was nearly 30-fold higher than published incidence rates for the general Olmsted County population. VTE incidence was highest within 7 days after NH admission, and NHVTE was associated with significantly reduced survival. These data can inform future research and construction of clinical trials regarding short-term prophylaxis.

Keywords

epidemiology - venous thromboembolism - nursing home - incidence - survival

Authors' Contributions

Research design: T.M.P., C.Y.S., J.A.E., K.R.B., A.A.A., J.A.H. and C.L.L.


Data Collection: C.Y.S. and J.A.E.


Statistical analysis: T.M.P., C.Y.S. and K.R.B.


Interpretation of findings and manuscript preparation: T.M.P., C.Y.S., J.A.E., K.R.B., A.A.A., J.A.H. and C.L.L.


All authors have seen the final submitted version of the manuscript. All authors had full access to the data in the study and take responsibility for the data integrity and accuracy of the data analyses.


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