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Predictors and Causes of Long-Term Mortality in Elderly Patients with Acute Venous Thromboembolism : A Prospective Cohort Study

Joseph Osterwalder, N Faller, A Limacher, M Méan, Marc Righini & Markus Aschwanden

abstract

BACKGROUND:

Long-term predictors and causes of death are understudied in elderly patients with acute venous thromboembolism.

METHODS:

We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was overall mortality. We explored the association between patient baseline characteristics and mortality, adjusting for other baseline variables and periods of anticoagulation as a time-varying covariate. Causes of death over time were adjudicated by a blinded, independent committee.

RESULTS:

The median age was 75 years. During a median follow-up period of 30 months, 206 patients (21%) died. Independent predictors of overall mortality were age (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.05-1.65, per decade), active cancer (HR, 5.80; 95% CI, 4.22-7.97), systolic blood pressure <100 mm Hg (HR, 2.77; 95% CI, 1.56-4.92), diabetes mellitus (HR, 1.50; 95% CI, 1.02-2.22), low physical activity level (HR, 1.92; 95% CI, 1.38-2.66), polypharmacy (HR, 1.41; 95% CI, 1.01-1.96), anemia (HR, 1.48; 95% CI, 1.07-2.05), high-sensitivity C-reactive protein >40 mg/L (HR, 1.88; 95% CI, 1.36-2.60), ultra-sensitive troponin >14 pg/mL (HR, 1.54; 95% CI, 1.06-2.25), and D-dimer >3000 ng/mL (HR, 1.45; 95% CI, 1.04-2.01). Cancer (34%), pulmonary embolism (18%), infection (17%), and bleeding (6%) were the most common causes of death.

CONCLUSIONS:

Elderly patients with acute venous thromboembolism have a substantial long-term mortality, and several factors, including polypharmacy and a low physical activity level, are associated with long-term mortality. Cancer, pulmonary embolism, infections, and bleeding are the most common causes of death in the elderly with venous thromboembolism.
   
keywords Cause of death; Elderly; Mortality; Predictor; Venous thromboembolism
   
citation Osterwalder J, Faller N, Limacher A, Méan M, Righini M, Aschwanden M. Predictors and Causes of Long-Term Mortality in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study. Am J Med 2016; 2017 130:198-206.
   
type journal paper/review (English)
date of publishing 10-2016
journal title Am J Med (2017 130/2)
publisher Elsevier
pages 198-206
PubMed 27742261
DOI 10.1016/j.amjmed.2016.09.008
link https://www-ncbi-nlm-nih-gov.kb.ezproxy1.sg.ch/pubmed/?term=27742261
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