Vena Caval Filter Use and Outcomes in Pulmonary Embolism

Study Questions:

What are the trends in utilization rates and outcomes for inferior vena cava (IVC) filter placement in patients with pulmonary embolism (PE) between 1999 and 2010?

Methods:

Using a national cohort study of Medicare fee-for-service beneficiaries ≥65 years of age with a principal discharge diagnosis of PE between 1999 and 2010, rates of IVC filter placement were identified. Rates of in-hospital, 30-day, 6-month, and 1-year mortality were calculated for all PE patients based on IVC filter placement status.

Results:

Among 556,658 patients hospitalized for PE, 94,427 underwent IVC filter placement. During the study period, the number of PE hospitalizations with IVC filter placement increased from 5,003 to 8,928 annually, a rate increase from 19.0 to 32.5/100,000 beneficiary-years (p < 0.001 for both). While the total number of PE hospitalizations increased during the study period, the rate of IVC filter placement did not change substantially (157.6 to 164.1 per 1,000 PE hospitalizations, p = 0.11). Short- and long-term mortality rates declined in all subgroups with PE during the study period (12.7% to 9% for 30-day mortality, 26.3% to 22.4% for 1-year mortality, p < 0.001 for both). Similar trends of declining mortality were seen for beneficiaries regardless of IVC filter placement status.

Conclusions:

The authors concluded that despite an increase in PE hospitalizations among Medicare fee-for-service beneficiaries over an 11-year period, the rate of IVC filter placement remained stable. The authors also concluded that mortality associated with PE hospitalizations is declining, regardless of IVC filter use.

Perspective:

As the number of PE hospitalizations increased, the rate of IVC filter placement remained consistent. Perhaps most importantly, mortality rates associated with PE declined, independent of IVC filter placement status. It is unclear what has contributed to this decline in mortality rate, possibly improved IVC filter design or placement techniques, improved anticoagulation regimens, and/or changing characteristics of PE patients. Nonetheless, this study highlights the importance of understanding when IVC filters are indicated and initiating appropriate treatment regimens for PE patients.

Clinical Topics: Anticoagulation Management, Geriatric Cardiology, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and Venothromboembolism

Keywords: Anticoagulants, Fee-for-Service Plans, Geriatrics, Hospital Mortality, Medicare, Outcome Assessment (Health Care), Patient Discharge, Pulmonary Embolism, Vena Cava Filters, Vena Cava, Inferior, Secondary Prevention, Venous Thromboembolism


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