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

Faller, Nicolas; Limacher, Andreas; Méan, Marie; Righini, Marc; Aschwanden, Markus; Beer, Jürg Hans; Frauchiger, Beat; Osterwalder, Josef; Kucher, Nils; Lämmle, Bernhard; Cornuz, Jacques; Angelillo-Scherrer, Anne; Matter, Christian M.; Husmann, Marc; Banyai, Martin; Staub, Daniel; Mazzolai, Lucia; Hugli, Olivier; Rodondi, Nicolas and Aujesky, Drahomir (2017). Predictors and Causes of Long-Term Mortality in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study. American journal of medicine, 130(2), pp. 198-206. Elsevier 10.1016/j.amjmed.2016.09.008

[img] Text
Faller AmJMed 2017.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (746kB) | Request a copy

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Hämatologie (Erwachsene)

UniBE Contributor:

Limacher, Andreas; Kucher, Nils; Lämmle, Bernhard; Angelillo, Anne; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0002-9343

Publisher:

Elsevier

Language:

English

Submitter:

Katrin Kölliker-Schütz

Date Deposited:

06 Dec 2016 15:42

Last Modified:

15 Feb 2017 13:02

Publisher DOI:

10.1016/j.amjmed.2016.09.008

PubMed ID:

27742261

BORIS DOI:

10.7892/boris.91106

URI:

https://boris.unibe.ch/id/eprint/91106

Actions (login required)

Edit item Edit item
Provide Feedback