Methods of identifying and treating venous thromboembolism (VTE) have gotten better in the past 30 years, yet the annual event rate of VTE is still high. Indeed, it is on the rise, say researchers from University of Massachusetts in Worcester and McMaster University in Hamilton, Ontario, Canada. Is the increased rate of VTE events because diagnostic methods have improved, or are current prevention and treatment strategies falling short?
Maybe both, the researchers conclude. Clinicians are “clearly detecting more cases” than they were before the introduction of computed tomography pulmonary angiography. And between 1985 and 2009, the use of ≥ 1 noninvasive diagnostic methods for detecting VTE increased from about two-thirds of patients to nearly all patients (P < .001). But the researchers raise the question: How much of the increase in cases reflects small, clinically insignificant pulmonary embolisms?
Related: The Changing Landscape of VTE Treatment (Video)
They also point out that greater awareness of VTE as an important public health problem may have led clinicians to refer more patients for evaluation. Their study shows that the proportion of patients who received any form of objective diagnostic testing also has grown over time.
This study is the first population-based surveillance project of VTE to provide data about trends in annual event rates of first-time and recurrent VTE between 1985 and 2009. The study is based on data from 5,487 residents of Worcester, Massachusetts, who participated in the Worcester VTE study. That long-running study, the researchers say, afforded them a “unique opportunity” to examine trends in the magnitude, characteristics, and diagnostic workup for VTE “from the perspective of a well-characterized population.”
Between 1985 and 2009, 5,025 patients were diagnosed with acute pulmonary embolism or lower-extremity deep vein thrombosis. Of those, 3,887 had VTE for the first time, and 1,138 had recurrent VTE. The proportion of first-time VTE increased from about 66% in the initial cohort to about 80% in the 2009 cohort (P < .001). Interestingly, the rate of recurrent VTE dropped from 39 per 100,000 in 1985/86 to 19 per 100,000 in 2003 (95% confidence interval [CI], 15-23), then rose back to 35 per 100,000 in 2009 (95% CI, 29-40).
Related: Pulmonary Vein Thrombosis Associated With Metastatic Carcinoma
After adjustment for sex and age, the annual event rate was 142 per 100,000 for the entire study period, from 112 in 1985/86 to 168 in 2009. That’s higher than the incidence of the 2 leading cancers (prostate and breast) and > 15 times the rate of HIV in white Americans, the researchers point out. Also, the event rate of acute pulmonary embolism was nearly equivalent to the annual incidence of ischemic stroke. In other words, VTE is still a “major national health problem with a substantial disease burden”—one that may get even heavier. Given the aging of the U.S. population, the projected disease burden of VTE is expected to more than double by 2050.
Source
Huang W, Goldberg RJ, Anderson FA, Kiefe CI, Spencer FA. Am J Med. 2014;127(9):829-839.
doi: 10.1016/j.amjmed.2014.
