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Inpatient Versus Outpatient Acute Venous Thromboembolism Management: Trends and Postacute Healthcare Utilization From 2011 to 2018.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2021 Oct 19; Vol. 10 (20), pp. e020428. Date of Electronic Publication: 2021 Oct 08. - Publication Year :
- 2021
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Abstract
- Background Acute outpatient management of venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is perceived to be as safe as inpatient management in some settings. How widely this strategy is used is not well documented. Methods and Results Using MarketScan administrative claims databases for years 2011 through 2018, we identified patients with International Classification of Diseases ( ICD ) codes indicating incident VTE and trends in the use of acute outpatient management. We also evaluated healthcare utilization and hospitalized bleeding events in the 6 months following the incident VTE event. A total of 200 346 patients with VTE were included, of whom 50% had evidence of PE. Acute outpatient management was used for 18% of those with PE and 57% of those with DVT only, and for both DVT and PE its use increased from 2011 to 2018. Outpatient management was less prevalent among patients with cancer, higher Charlson comorbidity index scores, and whose primary treatment was warfarin as compared with a direct oral anticoagulant. Healthcare utilization in the 6 months following the incident VTE event was generally lower among patients managed acutely as outpatients, regardless of initial presentation. Acute outpatient management was associated with lower hazard ratios of incident bleeding risk for both patients who initially presented with PE (0.71 [95% CI, 0.61, 0.82]) and DVT only (0.59 [95% CI, 0.54, 0.64]). Conclusions Outpatient management of VTE is increasing. In the present analysis, it was associated with lower subsequent healthcare utilization and fewer bleeding events. However, this may be because healthier patients were managed on an outpatient basis.
- Subjects :
- Anticoagulants adverse effects
Hemorrhage chemically induced
Hemorrhage epidemiology
Humans
Inpatients
Outpatients
Patient Acceptance of Health Care statistics & numerical data
Pulmonary Embolism diagnosis
Pulmonary Embolism epidemiology
Pulmonary Embolism therapy
Venous Thromboembolism diagnosis
Venous Thromboembolism drug therapy
Venous Thromboembolism epidemiology
Venous Thrombosis
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 10
- Issue :
- 20
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 34622678
- Full Text :
- https://doi.org/10.1161/JAHA.120.020428