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The impact of co-morbidity on the disease burden of VTE

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Abstract

Venous thromboembolism (VTE) is often accompanied by co-morbidities, which complicate and confound data interpretation concerning VTE-related mortality, costs and quality of life. We aimed to assess the contribution of co-morbidities to the burden of VTE. The PREFER in VTE registry, across seven European countries, documented and followed acute VTE patients over 12 months. Patients with co-morbidities were grouped in major co-morbidity groups: cancer, cardiovascular (CV) comorbidity (other than VTE), CV risks, venous, renal, liver, respiratory, bone and joint diseases, and lower extremity paralysis. Mortality rates and health-related quality of life (HrQoL) utility values grouped per co-morbidity were compared to the UK general population. Regression analyses were performed to determine the impact of co-morbidities on mortality and HrQoL. VTE were analyzed together and separately as pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 3455 patients were included, 40.5% with PE and 59.5% with DVT. 13% and 16% of the PE and DVT patients had no co-morbidities and had a 12-month mortality rate of 1.8% and 1.7%, respectively. Frequency and severity of co-morbidities increased mortality rates up to 30%. The EQ-5D-5L index in patients without co-morbidities were 0.826 and 0.838 for PE and DVT. These scores decreased to 0.638 and 0.555 in the presence of co-morbidities. Co-morbidities in VTE patients are common. VTE had an impact on mortality and HrQoL, and additional impact of co-morbidities was seen. Awareness of the presence of co-morbidities is important when making VTE-related treatment decisions. The presence of co-morbidities in PE and DVT patients is common and their frequency and severity in VTE patients have a substantial impact on mortality rates and HrQoL. When adjusting for co-morbidities, the impact of VTE on mortality as well as health-related quality of life remains present. Assessing patients without consideration of co-morbidities might lead to misinterpretations of the disease burden of PE and DVT.

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Data availability

The dataset analyzed during the current study are from the PREFER in VTE registry and are not publicly available.

Abbreviations

CV:

Cardiovascular

DVT:

Deep-vein thromboembolism

PE:

Pulmonary embolism

VTE:

Venous thromboembolism

References

  1. Oger E group E-Gs (2000) Incidence of venous thromboembolism: a community-based study in Western France. Thromb Haemost 84(05):657–660

    Google Scholar 

  2. Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, Greer IA, Heit JA, Hutchinson JL, Kakkar AK (2007) Venous thromboembolism (VTE) in Europe. Thromb Haemost 98(04):756–764

    CAS  PubMed  Google Scholar 

  3. Spencer FA, Emery C, Lessard D, Anderson F, Emani S, Aragam J, Becker RC, Goldberg RJ (2006) The worcester venous thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med 21(7):722–727

    Article  Google Scholar 

  4. Arshad N, Isaksen T, Hansen J-B, Brækkan SK (2017) Time trends in incidence rates of venous thromboembolism in a large cohort recruited from the general population. Eur J Epidemiol 32(4):299–305

    Article  Google Scholar 

  5. Agnelli G, Gitt AK, Bauersachs R, Fronk E-M, Laeis P, Mismetti P, Monreal M, Willich SN, Wolf W-P, Cohen AT (2015) The management of acute venous thromboembolism in clinical practice–study rationale and protocol of the European PREFER in VTE Registry. Thromb J 13(1):41

    Article  Google Scholar 

  6. Willich SN, Chuang L-H, van Hout B, Gumbs P, Jimenez D, Kroep S, Bauersachs R, Monreal M, Agnelli G, Cohen A (2018) Pulmonary embolism in Europe—Burden of illness in relationship to healthcare resource utilization and return to work. Thromb Res. https://doi.org/10.1016/j.thromres.2018.02.009

    Article  PubMed  Google Scholar 

  7. Cohen AT, Gitt AK, Bauersachs R, Fronk E-M, Laeis P, Mismetti P, Monreal M, Willich SN, Bramlage P, Agnelli G (2017) The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry. Thromb Haemost 13(1):41

    Google Scholar 

  8. Gouin B, Blondon M, Jiménez D, Fernández-Capitán C, Bounameaux H, Soler S, Duce R, Sahuquillo JC, Ruiz-Giménez N, Monreal M (2017) Clinical prognosis of nonmassive central and noncentral pulmonary embolism: a registry-based cohort study. Chest 151(4):829–837

    Article  Google Scholar 

  9. Sindet-Pedersen C, Pallisgaard JL, Staerk L, Gerds TA, Fosbøl EL, Torp-Pedersen C, Gislason G, Olesen JB (2017) Comparative safety and effectiveness of rivaroxaban versus VKAs in patients with venous thromboembolism. Thromb Haemost 117(06):1182–1191

    Article  Google Scholar 

  10. UK mortality rate 2013 (2013) Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths. Accessed Apr 2017

  11. Steyerberg EW, Eijkemans MJ, Habbema JDF (1999) Stepwise selection in small data sets: a simulation study of bias in logistic regression analysis. J Clin Epidemiol 52(10):935–942

    Article  CAS  Google Scholar 

  12. Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B (2018) Valuing health-related quality of life: an EQ-5 D-5 L value set for England. Health Econ 27(1):7–22

    Article  Google Scholar 

  13. Gouveia M, Pinheiro L, Costa J, Borges M (2016) Pulmonary embolism in Portugal: epidemiology and in-hospital mortality. Acta Med Port 29(7–8):432–440

    Article  Google Scholar 

  14. Luong NV, Kroll MH, Vu K (2017) Recurrence of venous thromboembolism among adults acute leukemia patients treated at the University of Texas MD Anderson Cancer Center: Incidence and risk factors. Thromb Res 156:14–19

    Article  CAS  Google Scholar 

  15. Choi S, Lee K-W, Bang S-M, Kim S, Lee J-O, Kim YJ, Kim JH, Park YS, Kim D-W, Kang S-B (2011) Different characteristics and prognostic impact of deep-vein thrombosis/pulmonary embolism and intraabdominal venous thrombosis in colorectal cancer patients. Thromb Haemost 105(06):1084–1094

    Google Scholar 

  16. Al Diab AI (2010) Cancer-related venous thromboembolism: insight into underestimated risk factors. Hematol/Oncol Stem Cell Ther 3(4):191–195

    Article  Google Scholar 

  17. Sawant S, Banumathy S, Daddi A, Dhir A (2012) Pulmonary embolism in cancer patients. Indian J Cancer 49(1):119

    Article  CAS  Google Scholar 

  18. Smith TR, Nanney AD, Lall RR, Graham RB, McClendon J, Lall RR, Adel JG, Zakarija A, Cote DJ, Chandler JP (2015) Development of venous thromboembolism (VTE) in patients undergoing surgery for brain tumors: results from a single center over a 10 year period. J Clin Neurosci 22(3):519–525

    Article  Google Scholar 

  19. Jameson SS, Rankin KS, Desira NL, James P, Muller SD, Reed MR, Rangan A (2014) Pulmonary embolism following ankle fractures treated without an operation—an analysis using National Health Service data. Injury 45(8):1256–1261

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the invaluable contribution of the PREFER in VTE Registry investigators and patients.

Author information

Authors and Affiliations

  1. Pharmerit International, Marten Meesweg 107, 3068 AV, Rotterdam, The Netherlands

    Sonja Kroep & Ling-Hsiang Chuang

  2. Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Alexander Cohen

  3. Daiichi-Sankyo Europe GmbH, Munich, Germany

    Pearl Gumbs

  4. University of Sheffield, Sheffield, UK

    Ben van Hout

  5. Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

    Manuel Monreal

  6. Universidad Católica de Murcia, Murcia, Spain

    Manuel Monreal

  7. Charité - Universitätsmedizin Berlin, Berlin, Germany

    Stefan N. Willich

  8. Herzzentrum Ludwigshafen, Ludwigshafen, Germany

    Anselm Gitt

  9. Klinikum Darmstadt GmbH, Darmstadt, Germany

    Rupert Bauersachs

  10. Center of Thrombosis and Hemostasis, University of Mainz, Mainz, Germany

    Rupert Bauersachs

  11. University of Perugia, Perugia, Italy

    Giancarlo Agnelli

Authors
  1. Sonja Kroep
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  2. Ling-Hsiang Chuang
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  3. Alexander Cohen
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  4. Pearl Gumbs
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  5. Ben van Hout
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  6. Manuel Monreal
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  7. Stefan N. Willich
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  8. Anselm Gitt
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  9. Rupert Bauersachs
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  10. Giancarlo Agnelli
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Contributions

SK, LHC, AC, BH, PG analyzed and interpreted the data and co-morbidity specific analyses. SK, LHC, AC, BH, PG, MM, SW, AG, RB, GA contributed in writing and reviewing of the manuscript.

Corresponding author

Correspondence to Sonja Kroep.

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Conflict of interest

S. Kroep, LH. Chuang and B. van Hout have served as consultants for Daiichi-Sankyo; A. Cohen, M. Monreal, S. Willich, A. Gitt, R. Bauersachs and G. Agnelli have received honoraria from Daiichi-Sankyo for participating in the advisory committee; P. Gumbs is an employee of Daiichi-Sankyo Europe GmbH.

Ethics approval and consent to participate

Prior to study commencement, the registry protocol was approved by the responsible ethics committees for the participating countries and the relevant hospital-based institutional review boards. All patients enrolled in the registry first provided written informed consent. The design and methods of the PREFER in VTE registry have previously been described, including more information concerning patients, data collection and definitions [5].

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Kroep, S., Chuang, LH., Cohen, A. et al. The impact of co-morbidity on the disease burden of VTE. J Thromb Thrombolysis 46, 507–515 (2018). https://doi.org/10.1007/s11239-018-1732-0

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  • DOI: https://doi.org/10.1007/s11239-018-1732-0

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