Incidence of venous thromboembolism in care homes: a prospective cohort study

Abstract

BackgroundCare home residents have venous thromboembolism (VTE) risk profiles similar to medical inpatients; however, the epidemiology of VTE in care homes is unclear.AimTo determine the incidence of VTE in care homes.Design and settingObservational cohort study of 45 care homes in Birmingham and Oxford, UK.MethodA consecutive sample of care home residents was enrolled and followed up for 12 months. Data were collected via case note reviews of care home and GP records; mortality information was supplemented with Health and Social Care Information Centre (now called NHS Digital) cause of death data. All potential VTE events were adjudicated by an independent committee according to three measures of diagnostic certainty: definite VTE (radiological evidence), probable VTE (high clinical indication but no radiological evidence), or possible VTE (VTE cannot be ruled out). (Study registration number: ISTCTN80889792.)ResultsThere were 1011 participants enrolled, and the mean follow-up period was 312 days (standard deviation 98 days). The incidence rate was 0.71 per 100 person years of observation (95% confidence interval [CI] = 0.26 to 1.54) for definite VTE, 0.83 per 100 person years (95% CI = 0.33 to 1.70) for definite and probable VTE, and 2.48 per 100 person years (95% CI = 1.53 to 3.79) for definite, probable, and possible VTE.ConclusionThe incidence of VTE in care homes in this study (0.71–2.48 per 100 person years) is substantial compared with that in the community (0.117 per 100 person years) and in people aged ≥70 years (0.44 per 100 person years). Further research regarding risk stratification and VTE prophylaxis in this population is needed.

Venous Thromboembolism (VTE) Incidence and VTE-Associated Survival among Olmsted County Residents of Local Nursing Homes

“…In both studies, a majority of individuals were long-time NH residents at study start. Thus, our finding of an inverse association between incident VTE and time since admission may contribute to lower estimates of NHVTE/100,000 NH-PY (1,390–1,580[30] and 830[28], respectively) compared to our estimate of 3,653.…”

“…Comparison with other findings is hampered by multiple between-study differences (e.g., exclusion rules, person-years-at-risk, and calendar years of study). Of very few investigations of NHVTE incidence and associated mortality,[28–31] most were limited by reliance on diagnosis/procedure codes obtained from NH administrative data and/or Medicare claims. As part of a previous study,[32] we compared characteristics of first VTE events among NH residents identified using International Classification of Diseases ( ICD-9-CM ) diagnosis codes[33] from NH administrative data[34] with those for REP-identified VTE events using detailed medical-record review among Olmsted County residents of the same nursing homes during the same time period.…”

“…Two previous studies[28,30] ascertained NHVTE using retrospective review of detailed medical records approximating the approach used here. Both studies classified events as definite or probable using criteria resembling our criteria for objectively-verified and clinically-determined.…”

“…[30] The other study identified residents of care homes in two major cities; care-home participation rates were low, refusal rates among eligible NH residents were high, and individuals with life-expectancy ˂6 months were excluded, as were individuals lacking capacity to consent and no available proxy. [28] The numbers of definite plus probable VTE events were 26[30] and seven[28], respectively. In both studies, a majority of individuals were long-time NH residents at study start.…”

An Analysis of Risk Factors for Deep Vein Thrombosis in the Lower Limbs and Nursing Strategies

“…It is the third leading cause of death associated with cardiovascular diseases after ischemic heart disease and stroke [4]. Hospitalization is among the major risk factors of VTE [5]. This study was concerned with the risk factors and integrated intervention measures for DVT among the inpatients.…”