title: Predictors and Causes of Long-Term Mortality in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study.
abstract: Long-term predictors and causes of death are understudied in elderly patients with acute venous thromboembolism.
  
  
  
  We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was overall mortality. We explored the association between patient baseline characteristics and mortality, adjusting for other baseline variables and periods of anticoagulation as a time-varying covariate. Causes of death over time were adjudicated by a blinded, independent committee.
  
  
  
  The median age was 75 years. During a median follow-up period of 30 months, 206 patients (21%) died. Independent predictors of overall mortality were age (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.05-1.65, per decade), active cancer (HR, 5.80; 95% CI, 4.22-7.97), systolic blood pressure <100 mm Hg (HR, 2.77; 95% CI, 1.56-4.92), diabetes mellitus (HR, 1.50; 95% CI, 1.02-2.22), low physical activity level (HR, 1.92; 95% CI, 1.38-2.66), polypharmacy (HR, 1.41; 95% CI, 1.01-1.96), anemia (HR, 1.48; 95% CI, 1.07-2.05), high-sensitivity C-reactive protein >40 mg/L (HR, 1.88; 95% CI, 1.36-2.60), ultra-sensitive troponin >14 pg/mL (HR, 1.54; 95% CI, 1.06-2.25), and D-dimer >3000 ng/mL (HR, 1.45; 95% CI, 1.04-2.01). Cancer (34%), pulmonary embolism (18%), infection (17%), and bleeding (6%) were the most common causes of death.
  
  
  
  Elderly patients with acute venous thromboembolism have a substantial long-term mortality, and several factors, including polypharmacy and a low physical activity level, are associated with long-term mortality. Cancer, pulmonary embolism, infections, and bleeding are the most common causes of death in the elderly with venous thromboembolism.
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, University of Bern, Switzerland. Electronic address: nicolas.faller@insel.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Faller
authors.affiliation: Clinical Trials Unit Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine, University of Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Limacher
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, University of Bern, Switzerland; Division of Internal Medicine, Lausanne University Hospital, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Méan
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospital, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.affiliation: Division of Angiology, Basel University Hospital, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Aschwanden
authors.affiliation: Department of Internal Medicine, Cantonal Hospital of Baden, Switzerland.
authors.forename: Jürg Hans
authors.initials: JH
authors.lastname: Beer
authors.affiliation: Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Frauchiger
authors.affiliation: Department of Emergency Medicine, Cantonal Hospital of St Gallen, Switzerland.
authors.forename: Josef
authors.initials: J
authors.lastname: Osterwalder
authors.affiliation: Division of Angiology, Bern University Hospital, Switzerland.
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
authors.affiliation: University Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lämmle
authors.affiliation: Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Switzerland.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
authors.affiliation: University Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Angelillo-Scherrer
authors.affiliation: Center for Molecular Cardiology, University of Zurich, and Clinic for Cardiology, University Heart Center, Zurich University Hospital, Switzerland.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Matter
authors.affiliation: Division of Angiology, Zurich University Hospital, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Husmann
authors.affiliation: Division of Angiology, Cantonal Hospital of Lucerne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Banyai
authors.affiliation: Division of Angiology, Basel University Hospital, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Staub
authors.affiliation: Division of Angiology, Lausanne University Hospital, Switzerland.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mazzolai
authors.affiliation: Emergency Department, Lausanne University Hospital, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hugli
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D048909:Diabetes Complications / Q000401:mortality; D015444:Exercise; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications; D019338:Polypharmacy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014336:Troponin / Q000097:blood; D054556:Venous Thromboembolism / Q000209:etiology / Q000401:mortality*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D014336:Troponin; C036309:fibrin fragment D; D002097:C-Reactive Protein
keywords: Cause of death; Elderly; Mortality; Predictor; Venous thromboembolism