In-hospital mortality benefit of inferior vena cava filters in patients with pulmonary embolism and congestive heart failure

Vibhor Wadhwa, Narendra B. Gutta, Premal S. Trivedi, Kshitij Chatterjee, Osman Ahmed, Robert K. Ryu, Sanjeeva P. Kalva

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVE. Pulmonary embolism (PE) is associated with a higher mortality rate in patients with congestive heart failure (CHF) than in those without heart failure. The purpose of this study was to evaluate if inferior vena cava (IVC) filter placement provides any mortality benefit in patients admitted with CHF and PE. MATERIALS AND METHODS. The 2005–2014 Nationwide Inpatient Sample (NIS) was used for this study. Adults (≥ 18 years old) with PE were identified using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnosis codes. Patients with CHF were identified using the Elixhauser comorbidity variable (CM_CHF) in the NIS database. IVC filter placement was identified using the ICD-9-CM procedure code 38.7 (interruption of the vena cava). A multivariate logistic regression model was used to determine the association of IVC filter placement with in-hospital mortality. The model was adjusted for demographics, hospital characteristics, comorbidities, and PE severity indexes (pressor dependence, mechanical ventilation, nonseptic shock, and use of thrombolytic therapy). RESULTS. During the study years, 425,877 patients with a comorbidity of CHF were hospitalized with PE (44% male; mean age, 71.5 years old). Of them, 67,237 patients (15.8%) received an IVC filter during the admission, and 50,338 (11.8%) died during the hospital stay. The all-cause in-hospital mortality rate among patients who received an IVC filter was 9.7% (6541 of 67,237 patients) compared with 12.2% (43,796 of 358,638 patients) among those without an IVC filter (p < 0.001), with an absolute risk reduction of 2.5%. The multivariate adjusted hazard ratio of in-hospital mortality associated with IVC filter placement was 0.535 (95% CI, 0.518–0.551; p < 0.001). CONCLUSION. A lower all-cause mortality rate was observed in patients with CHF and PE who received an IVC filter while hospitalized. In the absence of data from randomized controlled trials, this study suggests that IVC filters could help prevent in-hospital death among patients admitted with PE and CHF.

Original languageEnglish (US)
Pages (from-to)672-676
Number of pages5
JournalAmerican Journal of Roentgenology
Volume211
Issue number3
DOIs
StatePublished - Sep 1 2018

Fingerprint

Vena Cava Filters
Hospital Mortality
Pulmonary Embolism
Heart Failure
Comorbidity
Mortality
International Classification of Diseases
Inpatients
Logistic Models
Numbers Needed To Treat
Venae Cavae
Thrombolytic Therapy
Artificial Respiration
Shock
Length of Stay
Randomized Controlled Trials
Demography
Databases

Keywords

  • Congestive heart failure
  • Deep vein thrombosis
  • Inferior vena cava filter
  • Nationwide inpatient sample
  • Pulmonary embolism

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

In-hospital mortality benefit of inferior vena cava filters in patients with pulmonary embolism and congestive heart failure. / Wadhwa, Vibhor; Gutta, Narendra B.; Trivedi, Premal S.; Chatterjee, Kshitij; Ahmed, Osman; Ryu, Robert K.; Kalva, Sanjeeva P.

In: American Journal of Roentgenology, Vol. 211, No. 3, 01.09.2018, p. 672-676.

Research output: Contribution to journalArticle

Wadhwa, Vibhor ; Gutta, Narendra B. ; Trivedi, Premal S. ; Chatterjee, Kshitij ; Ahmed, Osman ; Ryu, Robert K. ; Kalva, Sanjeeva P. / In-hospital mortality benefit of inferior vena cava filters in patients with pulmonary embolism and congestive heart failure. In: American Journal of Roentgenology. 2018 ; Vol. 211, No. 3. pp. 672-676.
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abstract = "OBJECTIVE. Pulmonary embolism (PE) is associated with a higher mortality rate in patients with congestive heart failure (CHF) than in those without heart failure. The purpose of this study was to evaluate if inferior vena cava (IVC) filter placement provides any mortality benefit in patients admitted with CHF and PE. MATERIALS AND METHODS. The 2005–2014 Nationwide Inpatient Sample (NIS) was used for this study. Adults (≥ 18 years old) with PE were identified using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnosis codes. Patients with CHF were identified using the Elixhauser comorbidity variable (CM_CHF) in the NIS database. IVC filter placement was identified using the ICD-9-CM procedure code 38.7 (interruption of the vena cava). A multivariate logistic regression model was used to determine the association of IVC filter placement with in-hospital mortality. The model was adjusted for demographics, hospital characteristics, comorbidities, and PE severity indexes (pressor dependence, mechanical ventilation, nonseptic shock, and use of thrombolytic therapy). RESULTS. During the study years, 425,877 patients with a comorbidity of CHF were hospitalized with PE (44{\%} male; mean age, 71.5 years old). Of them, 67,237 patients (15.8{\%}) received an IVC filter during the admission, and 50,338 (11.8{\%}) died during the hospital stay. The all-cause in-hospital mortality rate among patients who received an IVC filter was 9.7{\%} (6541 of 67,237 patients) compared with 12.2{\%} (43,796 of 358,638 patients) among those without an IVC filter (p < 0.001), with an absolute risk reduction of 2.5{\%}. The multivariate adjusted hazard ratio of in-hospital mortality associated with IVC filter placement was 0.535 (95{\%} CI, 0.518–0.551; p < 0.001). CONCLUSION. A lower all-cause mortality rate was observed in patients with CHF and PE who received an IVC filter while hospitalized. In the absence of data from randomized controlled trials, this study suggests that IVC filters could help prevent in-hospital death among patients admitted with PE and CHF.",
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AU - Ahmed, Osman

AU - Ryu, Robert K.

AU - Kalva, Sanjeeva P.

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N2 - OBJECTIVE. Pulmonary embolism (PE) is associated with a higher mortality rate in patients with congestive heart failure (CHF) than in those without heart failure. The purpose of this study was to evaluate if inferior vena cava (IVC) filter placement provides any mortality benefit in patients admitted with CHF and PE. MATERIALS AND METHODS. The 2005–2014 Nationwide Inpatient Sample (NIS) was used for this study. Adults (≥ 18 years old) with PE were identified using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnosis codes. Patients with CHF were identified using the Elixhauser comorbidity variable (CM_CHF) in the NIS database. IVC filter placement was identified using the ICD-9-CM procedure code 38.7 (interruption of the vena cava). A multivariate logistic regression model was used to determine the association of IVC filter placement with in-hospital mortality. The model was adjusted for demographics, hospital characteristics, comorbidities, and PE severity indexes (pressor dependence, mechanical ventilation, nonseptic shock, and use of thrombolytic therapy). RESULTS. During the study years, 425,877 patients with a comorbidity of CHF were hospitalized with PE (44% male; mean age, 71.5 years old). Of them, 67,237 patients (15.8%) received an IVC filter during the admission, and 50,338 (11.8%) died during the hospital stay. The all-cause in-hospital mortality rate among patients who received an IVC filter was 9.7% (6541 of 67,237 patients) compared with 12.2% (43,796 of 358,638 patients) among those without an IVC filter (p < 0.001), with an absolute risk reduction of 2.5%. The multivariate adjusted hazard ratio of in-hospital mortality associated with IVC filter placement was 0.535 (95% CI, 0.518–0.551; p < 0.001). CONCLUSION. A lower all-cause mortality rate was observed in patients with CHF and PE who received an IVC filter while hospitalized. In the absence of data from randomized controlled trials, this study suggests that IVC filters could help prevent in-hospital death among patients admitted with PE and CHF.

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KW - Deep vein thrombosis

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