Predictors of survival after deep vein thrombosis and pulmonary embolism - A population-based, cohort study

Background: Because reported survival after venous thromboembolism (VTE) varies widely, we performed a population-based retrospective cohort study to estimate survival, compare observed with expected survival, and determine predictors of short-term (less than or equal to 7 days) and long-term survival (>7 days) after VTE. Methods: We followed the 25-year (1966-1990) inception cohort (n = 2218) of Olmsted County, Minnesota, patients with deep vein thrombosis alone (DVT) or pulmonary embolism with or without deep vein thrombosis (PE +/- DVT) forward in time until death or the last clinical contact. Results: During 14629 person-years of follow-up, 1333 patients died. Seven-day, 30-day, and 1-year VTE survival rates were 74.8% (DVT, 96.2%; PE +/- DVT, 59.1%), 72.0% (DVT, 94.5%; PE +/- DVT, 55.6%), and 63.6% (DVT, 85.4%; PE +/- DVT, 47.7%), respectively. Observed survival after DVT, PE +/- DVT, and overall was significantly worse than expected for Minnesota whites of similar age and sex (P < .001). More than one third of deaths occurred on the date of onset or after VTE that was unrecognized during life. Short-term survival improved during the 25-year study period, while longterm survival was unchanged. After adjusting for comorbid conditions, PE +/- DVT was an independent predictor of reduced survival for up to 3 months after onset compared with DVT alone. Other independent predictors of both short- and long-term survival included age, body mass index, patient location at onset, malignancy, congestive heart failure, neurologic disease, chronic lung disease, recent surgery, and hormone therapy. Additional independent predictors of long-term survival included tobacco smoking, other cardiac disease, and chronic renal disease. Conclusions: Survival after VTE, and especially after PE +/- DVT, is much worse than reported, and significantly less than expected survival. Compared with DVT alone, symptomatic PE +/- DVT is an independent predictor of reduced survival for up to 3 months after onset, implying that treatment for the 2 disorders should be different.