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A Population-Based, Cohort Study

John A. Heit, MD; Marc D. Silverstein, MD; David N. Mohr, MD; Tanya M. Petterson, MS; W. Michael O'Fallon, PhD; L. Joseph Melton III, MD

Arch Intern Med. 1999;159:445-453.

Background  Because reported survival after venous thromboembolism (VTE) varies widely, we performed a population-based retrospective cohort study to estimate survival, compare observed with expected survival, and determine predictors of short-term (7 days) and long-term survival (>7 days) after VTE.

Methods  We followed the 25-year (1966-1990) inception cohort (n=2218) of Olmsted County, Minnesota, patients with deep vein thrombosis alone (DVT) or pulmonary embolism with or without deep vein thrombosis (PE ± DVT) forward in time until death or the last clinical contact.

Results  During 14,629 person-years of follow-up, 1333 patients died. Seven-day, 30-day, and 1-year VTE survival rates were 74.8% (DVT, 96.2%; PE ± DVT, 59.1%), 72.0% (DVT, 94.5%; PE ± DVT, 55.6%), and 63.6% (DVT, 85.4%; PE ± DVT, 47.7%), respectively. Observed survival after DVT, PE ± DVT, and overall was significantly worse than expected for Minnesota whites of similar age and sex (P<.001). More than one third of deaths occurred on the date of onset or after VTE that was unrecognized during life. Short-term survival improved during the 25-year study period, while long-term survival was unchanged. After adjusting for comorbid conditions, PE ± DVT was an independent predictor of reduced survival for up to 3 months after onset compared with DVT alone. Other independent predictors of both short- and long-term survival included age, body mass index, patient location at onset, malignancy, congestive heart failure, neurologic disease, chronic lung disease, recent surgery, and hormone therapy. Additional independent predictors of long-term survival included tobacco smoking, other cardiac disease, and chronic renal disease.

Conclusions  Survival after VTE, and especially after PE ± DVT, is much worse than reported, and significantly less than expected survival. Compared with DVT alone, symptomatic PE ± DVT is an independent predictor of reduced survival for up to 3 months after onset, implying that treatment for the 2 disorders should be different.

From the Departments of Medicine, Divisions of Cardiovascular Diseases, Section of Vascular Medicine, and the Section of Hematology Research (Dr Heit) and Area General Internal Medicine (Drs Silverstein and Mohr), and Health Sciences Research, Sections of Clinical Epidemiology (Drs Silverstein and Melton) and Biostatistics (Ms Petterson and Dr O'Fallon), Mayo Clinic and Mayo Foundation, Rochester, Minn.

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