The prevalence of congestive heart failure (CHF) in the United States has been on the rise over the last decade. This is likely because of the standardized management of hospitalized patients with CHF decompensation, allowing patients with CHF to live longer. These patients are known to posses increased risk of developing deep vein thrombosis (DVT). We analyzed data from the Nationwide Inpatient Sample (NIS) to examine the impact of DVT on mortality in patients hospitalized with CHF.
We conducted a retrospective analysis using the NIS, a database developed as part of the Healthcare Cost and Utilization Project sponsored by the federal Agency for Healthcare Research and Quality (AHRQ) from 1998 to 2007. NIS is the largest all‐payer inpatient care database in the United States, which contains data from approximately 8 million hospital stays per year. Adult patients (>18 years) with CHF during the 10‐year period were identified using ICD‐9 codes. The prevalence of DVT in this population was calculated. Characteristics of patients with and without DVT were compared, utilizing data over a 10‐year period starting with the index admission. Chi‐square, median, and Student t tests were used as appropriate. Multivariate regression for overall mortality and length of stay (LOS) was conducted using logistic and linear models, respectively. The analysis was controlled for sex, insurance status, and comorbidities using the Charlson comorbidity index.
A total of 7.8 million patients were hospitalized for CHF management from 1998 to 2007. The overall mortality during the index hospital admission was 6.9%. We observed a significant decline in index‐hospitalization mortality over the 10‐year period (7.9%–5.7%, P < 0.01). The prevalence of documented DVT during the index admission was 0.43%. Using bivariate analysis, patients with DVT were more likely female (55%), were slightly older (75 vs. 74 years, P < 0.01), had a longer LOS (median, 5 days; IQR, 3–8 days; vs. median, 8 days; IQR, 5–13 days; P < 0.01} and had a higher mortality rate (9.3% vs. 6.9%, P < 0.01). In multivariate regression we observed that patients with DVT were more likely to die than those without DVT after controlling for comorbidities (odds ratio, 1.38; P < 0.01). In addition, patients with systolic heart failure were less likely to have DVT than patients with diastolic heart failure (odds ratio, 0.81; P < 0.01). Other predictors of DVT included comorbidities and longer length of stay (3 days and above).
FIGURE . Graph representing odds ratio of developing DVT with increasing length of hospital stay (in days).
Deep vein thrombosis is an independent predictor of mortality among patients hospitalized with CHF. Increasing LOS in this population was associated with a significantly higher incidence of DVT. These findings from the nationally representative sample highlight the need for early mobilization and ambulation to prevent DVT in patients hospitalized with CHF.
O. Bolorunduro ‐ none; M. Bakht ‐ none; E. Brume ‐ none; M. Amer ‐ none
To cite this abstract:Bolorunduro O, Bakht M, Brume E, Amer M. Deep Vein Thrombosis As a Predictor of Mortality in Patients Hospitalized with Congestive Heart Failure: Results from the Nationwide Inpatient Sample (1998–2007) of Healthcare Cost and Utilization Project. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 22. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/deep-vein-thrombosis-as-a-predictor-of-mortality-in-patients-hospitalized-with-congestive-heart-failure-results-from-the-nationwide-inpatient-sample-19982007-of-healthcare-cost-and-utiliza/. Accessed April 1, 2020.