Changing trends in VTE: Pulmonary Embolism cases on Rise within the Last Decade
Danish study finds more elderly and patients with comorbidities being diagnosed.
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Key Takeaway
- Analysis of nationwide data suggests a significant increase in age- and sex- standardized hospitalisation rates of first-time venous thromboembolism (VTE), due to a marked increase in rate of pulmonary embolism, in Denmark within the last decade.
- This increase could reflect both, a real increase in the incidence of VTE and increased diagnostic awareness.
- Additionally, risk profile of this patient population with VTE has changed temporally with more elderly and patients with comorbidities being diagnosed.
Why This Matters
- These findings resemble previously reported evidence from Tromsø cohort study (1996–2012) and Worcester VTE-study (1985–2009).
- This strongly indicates that the observed development in VTE incidence most likely represents a real and widespread phenomenon.
Study Design
- This population-based study identified 67,426 patients (age, ≥18 years) with a first-time VTE hospitalisation at any Danish hospital between 2006 and 2015 from the Danish National Patient Registry.
- Age- and sex-standardised yearly hospitalisation rates for first-time VTE were calculated.
- 57.3% of patients (n=38,656) redeemed an anticoagulant drug prescription within 30 days of first VTE diagnosis.
- Funding: Bristol-Myers Squibb/Pfizer.
Key Results
- The age- and sex-standardised hospitalisation rate of first time VTE increased from 12.6 (95% CI, 12.3–12.9) per 10,000 person-years at risk in 2006 to 15.1 (95% CI, 14.7–15.4) per 10,000 person-years at risk in 2015, corresponding to a 19.8% increase in the rate of VTE.
- First-time hospitalisation for pulmonary embolism increased by 73.9% whereas for deep vein thrombosis dropped by 11.8%.
- Similar time trends were observed in analysis limited to patients whose validity of VTE diagnosis was supported by ≥1 filled prescription for an anticoagulant.
- The risk profile of patients changed during the study period:
- mean age in the overall VTE population increased from 63.5 (standard deviation [SD], 17.2) years in 2006 to 65.7 (SD, 16.5) years in 2015,
- comorbidity burden increased with proportion of patients with a Charlson's Comorbidity Index score of ≥1 increasing from 29.0% in 2006 to 46.0% in 2015.
- Diagnostic work seemed to change during the study period with:
- proportion of patients being examined with CT scanning or pulmonary angiography increased from 13.9% to 42.8%,
- use of ventilation/perfusion lung scan dropped from 22.5% to 15.5%.
Limitations
- Only VTE events leading to hospitalisation were included.
- Lack of data for use of oral contraceptives.
- Some cases of pulmonary embolism might have been missed because of low autopsy rates in Denmark.
- Possible misclassification of VTE diagnosis in administrative registries.
Reference
- Münster AM, Rasmussen TB, Falstie-Jensen AM, Harboe L, Stynes G, Dybro L, Hansen ML, Brandes A, Grove EL, Johnsen SP. A changing landscape: Temporal trends in incidence and characteristics of patients hospitalized with venous thromboembolism 2006-2015. Thromb Res. 2019;176:46-53. doi: 10.1016/j.thromres.2019.02.009. PMID: 30776687
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