title: Pharmacologic prophylaxis for venous thromboembolism and 30-day outcomes among older patients hospitalized with heart failure: an analysis from the ADHERE national registry linked to Medicare claims.
abstract: BACKGROUND
  Hospitalized medically ill patients are at greater risk for venous thromboembolism (VTE). Although pharmacologic prophylaxis regimens have reduced VTE risk in medically ill patients, associations with early postdischarge adverse clinical outcomes among patients with heart failure are unknown.
  
  
  OBJECTIVE
  We hypothesized that patients receiving pharmacologic VTE prophylaxis during hospitalization for heart failure would have lower rates of postdischarge adverse clinical outcomes than patients not receiving prophylaxis.
  
  
  METHODS
  Using data from the Acute Decompensated Heart Failure (ADHERE) registry linked to Medicare claims, we estimated 30-day postdischarge outcome rates for patients who received in-hospital subcutaneous heparin compared with patients who did not receive in-hospital VTE prophylaxis. We excluded patients who received warfarin or intravenous heparin. Outcomes included mortality, thromboembolic events, major adverse cardiovascular events, and all-cause readmission. We used propensity-score methods to estimate associations between VTE prophylaxis and each outcome. In a secondary analysis, we compared outcomes of patients receiving pharmacologic prophylaxis with unfractionated heparin (UFH) vs low-molecular-weight heparin (LMWH).
  
  
  RESULTS
  Of 36 799 eligible patients in 265 hospitals, 12 169 (33%) received pharmacologic VTE prophylaxis during the hospitalization. In unadjusted analysis and after weighting by the inverse probability of treatment, VTE prophylaxis was not associated with 30-day postdischarge mortality, thromboembolic events, major adverse cardiovascular events, or all-cause readmission. There were no differences in outcomes between patients receiving UFH and those receiving LMWH.
  
  
  CONCLUSIONS
  Pharmacologic VTE prophylaxis is provided to one-third of older patients hospitalized with heart failure. Treatment with LMWH or UFH did not have a statistically significant association with 30-day postdischarge outcomes.
authors: Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. rkociol@tuftsmedicalcenter.org
authors: Robb D
authors: RD
authors: Kociol
authors: Bradley G
authors: BG
authors: Hammill
authors: Adrian F
authors: AF
authors: Hernandez
authors: Winslow
authors: W
authors: Klaskala
authors: Roger M
authors: RM
authors: Mills
authors: Lesley H
authors: LH
authors: Curtis
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006493:Heparin / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016344:Medicare Part A; D010351:Patient Discharge; D010359:Patient Readmission; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin