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• W2000569576 abstract "This study from Denmark sought to evaluate whether common heart diseases that increase the risk of left-sided arterial embolism (such as heart failure, myocardial infarction, atrial fibrillation, atrial flutter) are also associated with an increased incidence of isolated pulmonary embolism (embolism without an apparent peripheral venous source). This was a case-control study with data gathered over 27 years from 1980 to 2007 from the Danish National Patient Registry, totaling 109,752 patients with a first recorded incident of pulmonary embolism (PE) or deep vein thrombosis (DVT), or both, in the lower limb both as primary or secondary discharge diagnosis. For each case, a risk-set sampling was utilized to select five population controls matched to index patient's age, sex, and date of diagnosis, totaling 541,561 population controls. Confounders, such as preceding inpatient cancer, fractures, trauma, surgery, pregnancy, obesity, and psychiatric disease (considering this a marker for antipsychotic drug use, a risk factor for pulmonary embolism), were identified and utilized to classify as provoked vs. unprovoked thromboembolisms. Statistical analysis comparing the frequency and proportion of venous thromboembolism cases and controls were calculated within categories of demographic variables, heart disease history, and candidate cofounders generating associations using odds ratios (OR) with 95% confidence intervals (CI) to generate a rate ratio. Multiple outcomes combining PE and DVT were compared by utilizing estimated OR with adjustment for matching factors and covariants. Among the groups, 59,790 had a diagnosis of DVT only, 45,282 had PE only, and 4680 had a diagnosis of DVT with PE. All three case groups had a higher prevalence of previous hospitalizations for heart disease for all cases with unprovoked presentation, particularly if there was a heart disease hospitalization in the previous 3 months. Isolated PE was associated with acute myocardial infarction (MI) (OR 43.5; 95% CI 39.6–47.8) and heart failure admission (OR 32.4; 95% CI 29.8–35.2) in the 3 months before the index case, and right-sided valvular heart disease was noted to also confer increased risk over left-sided lesions (OR 13.5; 95% CI 11.3–16.1 vs. OR 74.6; 95% CI 28.4–105.8). ORs associated with MI and heart failure admissions in the 3 months before the index case were substantially lower for DVT and for DVT with PE than for isolated PE. Much of this association was driven by coincident hospitalizations for heart disease and by diagnosis of venous thromboembolism. If there was a hospitalization for heart disease 3 months before the index case, but no embolism was diagnosed during that hospitalization, then the relative risk estimates were lower; acute MI showed an OR for PE of 6.3 (95% CI 5.5–7.2), OR for PE and DVT 4.2 (95% CI 2.4–3.3), and OR for DVT alone 2.9 (95% CI 2.4–3.3). A hospital encounter for cardiac disease>3 months before PE or DVT was associated with only slightly elevated OR. The risk estimates were similar, but lower when subset analysis was conducted from the year 2000 onward to reflect increased diagnostic accuracy and shorter bed rest after MI. One limitation of this study is that often, a diagnosis of PE precludes further investigation for a concomitant DVT. If this rate of under-diagnosis is independent of preceding heart disease, and assuming that cardiac diagnoses of PE in combination with DVT are less than PE alone, then this would bias the study to favor isolated PE. Another limitation of the study is that data were obtained from a national database wherein 15–20% of patients may not have met strict clinical criteria for the diagnosis of DVT." @default.
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• W2000569576 date "2012-01-01" @default.
• W2000569576 modified "2023-10-14" @default.
• W2000569576 title "Heart Disease May be a Risk Factor for Pulmonary Embolism without Peripheral Deep Venous Thrombosis" @default.
• W2000569576 doi "https://doi.org/10.1016/j.jemermed.2011.10.028" @default.
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