Clinical research study
Impact of Vena Cava Filters on In-hospital Case Fatality Rate from Pulmonary Embolism

https://doi.org/10.1016/j.amjmed.2011.05.025Get rights and content

Abstract

Background

The effects of vena cava filters on case fatality rate are not clear, although they are used increasingly in patients with pulmonary embolism. The purpose of this investigation is to determine categories of patients with pulmonary embolism in whom vena cava filters reduce in-hospital case fatality rate.

Methods

In-hospital all-cause case fatality rate according to the use of vena cava filters was determined in patients with pulmonary embolism discharged from short-stay hospitals throughout the United States using data from the Nationwide Inpatient Sample.

Results

In-hospital case fatality rate was marginally lower in stable patients who received a vena cava filter: 21,420 of 297,700 (7.2%) versus 135,240 of 1,712,800 (7.9%) (P < .0001). Filters did not improve in-hospital case fatality rate if deep venous thrombosis was diagnosed in stable patients. A few stable patients (1.4%) received thrombolytic therapy. Such patients who received a vena cava filter had a lower case fatality rate than those who did not: 550 of 8550 (6.4%) versus 2950 of 19,050 (15%) (P < .0001). Unstable patients who received thrombolytic therapy had a lower in-hospital case fatality rate with vena cava filters than those who did not: 505 of 6630 (7.6%) versus 2600 of 14,760 (18%) (P < .0001). Unstable patients who did not receive thrombolytic therapy also had a lower in-hospital case fatality rate with a vena cava filter: 4260 of 12,850 (33%) versus 19,560 of 38,000 (51%) (P < .0001).

Conclusion

At present, it seems prudent to consider a vena cava filter in patients with pulmonary embolism who are receiving thrombolytic therapy and in unstable patients who may not be candidates for thrombolytic therapy. Future prospective study is warranted to better define in which patients a filter is appropriate.

Section snippets

Materials and Methods

Patients discharged from short-stay hospitals throughout the United States from 1999 to 2008 with pulmonary embolism, and their in-hospital case fatality rate according to the use of vena cava filters, were identified from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.3 Patients with pulmonary embolism were stratified according to whether they were stable or unstable and further stratified according to whether they received

Results

From 1999 to 2008, 2,110,320 patients were discharged from short-stay hospitals in the United States with a diagnosis of pulmonary embolism. Demographic characteristics are listed Table 1 according to the various stratified groups.

Discussion

An impact on case fatality rate with vena cava filters was shown in unstable patients, whether or not they received thrombolytic therapy, and in stable patients who received thrombolytic therapy. Vena cava filters were associated with a lower all-cause in-hospital case fatality rate among unstable patients who received thrombolytic therapy (7.6% vs 18%) and lower all-cause case fatality rate in unstable patients who did not receive thrombolytic therapy (33% vs 51%). The majority of patients,

Conclusions

An impact on in-hospital case fatality rate with vena cava filters was shown in unstable patients, whether or not they received thrombolytic therapy, and in stable patients who received thrombolytic therapy. The majority of hospitalized patients with pulmonary embolism, however, were stable and did not receive thrombolytic therapy. Future prospective study with assessment of the absolute risks of filter placement in various subgroups of patients is warranted to better define in which patients a

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    Funding: None.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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