256569 Comorbidities associated with in-hospital death among hospitalizations with a diagnosis of venous thromboembolism

Sunday, October 28, 2012

James Tsai, MD, MPH, CPH , Division of Blood Disorders, CDC/NCBDDD, Atlanta, GA
Althea Grant, PhD , Division of Blood Disorders, CDC/NCBDDD, Atlanta, GA
J. Michael Soucie, PhD , Division of Blood Disorders, CDC/NCBDDD, Atlanta, GA
Amy Helwig, MD, MS , Center for Quality Improvement and Patient Safety, AHRQ, Rockville, MD
Hussain Yusuf, MD, MPH , Division of Blood Disorders, National Center for Birth Defects and Developmental Disabilities, CDC, Atlanta, GA
Sheree Boulet, DrPH , CDC/NCCDPHP, Atlanta, GA
Nimia Reyes, MD, MPH , Division of Blood Disorders, CDC/NCBDDD, Atlanta, GA
Hani Atrash, MD, MPH , Division of Blood Disorders, CDC/NCBDDD, Atlanta, GA
  
Background: Venous thromboembolism (VTE) is responsible for approximately 100,000-180,000 deaths per year in the US. This study was to determine whether and to what extent medical co-morbidities were associated with in-hospital death among hospitalizations with a diagnosis of VTE.

Method: We analyzed data from the 2009 National Inpatient Sample developed by the Agency for Healthcare Research and Quality (AHRQ) to estimate the case-fatality rates for in-hospital death among a sample of 156,180 hospitalizations with a VTE diagnosis and among subgroups stratified by demographic and clinical characteristics, and 29 comorbidities of AHRQ/Elixhauser index. We produced adjusted rate ratios (aRR) and 95% confidence intervals with multivariate regression models by using demographic, clinical characteristics, and comorbidities as predictors; status of in-hospital death was used as an outcome variable.

Results: In 2009, approximately 44,500 in-hospital deaths occurred among hospitalizations with a VTE diagnosis in the US, representing an overall case-fatality rate of 5.6%. The likelihoods of in-hospital death increased significantly (P<0.01) among hospitalizations with a VTE diagnosis and comorbidity of congestive heart failure [adjusted rate ratio (aRR)=1.43], chronic pulmonary disease (aRR=1.07), coagulopathy (aRR=1.84), liver disease (aRR=1.18), lymphoma (aRR=1.44), fluid and electrolyte disorders (aRR=1.91), metastatic cancer (aRR=1.90), peripheral vascular disorders (aRR=1.21), pulmonary circulation disorders (aRR=2.06), renal failure (aRR=1.38), solid tumor without metastasis (aRR=1.35), or weight loss (aRR=1.38), when compared to hospitalizations without the corresponding comorbidities.

Conclusions: The findings of this study underscore the importance of risk assessment and management of hospitalized VTE patients with concurrent medical comorbidities that may place them at an increased risk of death.

Learning Areas:
Clinical medicine applied in public health
Epidemiology

Learning Objectives:
To learn whether and to what extent medical co-morbidities are associated with in-hospital death among hospitalizations with a diagnosis of venous thromboembolism in the United States

Keywords: Evidence Based Practice, Risk Assessment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the lead investigator in the study and the lead author in developing this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2075.0: Cardiovascular Disease Epidemiology Poster Session