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National and Regional Trends in Deep Vein Thrombosis Hospitalization Rates, Discharge Disposition, and Outcomes for Medicare Beneficiaries

  • Karl E. Minges
    Affiliations
    Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn

    Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
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  • Behnood Bikdeli
    Affiliations
    Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn

    Division of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY

    Cardiovascular Research Foundation, New York, NY
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  • Yun Wang
    Affiliations
    Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn

    Department of Biostatistics, Harvard School of Public Health, Boston, Mass
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  • Robert R. Attaran
    Affiliations
    Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
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  • Harlan M. Krumholz
    Correspondence
    Requests for reprints should be addressed to Harlan M. Krumholz, MD, SM, Department of Internal Medicine, Yale School of Medicine, 1 Church Street, Suite 200 New Haven, CT, 06520.
    Affiliations
    Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn

    Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn

    National Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn

    Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn
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      Abstract

      Introduction

      Older adults are at increased risk of developing deep vein thrombosis. Little is known about national trends of deep vein thrombosis hospitalizations in the context of primary and secondary prevention efforts.

      Methods

      Medicare standard analytic files were analyzed from 2015-2017 to identify Fee-For-Service patients aged ≥65 years who had a principal discharge diagnosis for deep vein thrombosis from 1999 to 2010. We reported the deep vein thrombosis hospitalization rates per 100,000 person-years as well as 30-day and 1-year mortality rates. We used mixed-effects models to calculate adjusted outcomes.

      Results

      Overall, there were 726,423 deep vein thrombosis hospitalizations in Medicare Fee-for-Service from 1999 to 2010. Deep vein thrombosis hospitalization rate adjusted for age, sex, and race decreased from 264 per 100,000 person-years in 1999 to 167 per 100,000 person-years in 2010, a relative decline of 36.7% (P < .0001). Hospitalizations decreased for all subgroups by age, sex, and race with the exception of black patients (316 to 382 per 100,000 person-years, a relative increase of 20.8%) (P < .0001). Hospital length of stay decreased from 6.1 days in 1999 to 5.0 days in 2010, and the proportion of patients discharged to home decreased from 57.2% to 44.1%. Risk-adjusted 30-day, 6-month, and 1-year mortality and 30-day readmission rates remained relatively stable across the study period, but were highest among women in recent years.

      Conclusions

      The overall deep vein thrombosis hospitalization rate decreased from 1999 to 2010, except for black patients. Decreases in hospitalizations may reflect changes in clinical practice with increased outpatient rather than inpatient management, and faster transitions to outpatient care for management of deep vein thrombosis.

      Keywords

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