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Venous thromboembolism occurs in 6.1% of people with heart failure and is driven by patient-specific clinical and laboratory factors instead of ejection fraction phenotype.
A large real-world cohort study reveals that venous thromboembolism (VTE)—encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE)—is a common complication in patients with heart failure (HF), with risk driven by clinical and laboratory factors rather than HF phenotype.
This retrospective study analyzed 4,211 adults newly diagnosed with heart failure. Subjects were classified into preserved, reduced, mildly reduced, and improved ejection fraction groups, with exclusion of those on chronic anticoagulation or with key prothrombotic ailments. Over a median follow-up of 6.2 years, incident VTE events were recorded across inpatient and outpatient settings. Risk predictors were examined via multivariable regression and Cox proportional hazards models.
VTE occurred in 256 patients (6.1%), confirming a vital burden in this population. Although crude incidence was higher in heart failure with preserved ejection fraction (HFpEF) when compared to heart failure with reduced ejection fraction (HFrEF), this link did not persist after adjustment, indicating that HF phenotype is not an independent predictor of VTE. Those who developed VTE were typically older and illustrated hypoalbuminemia, anemia, impaired renal function, and a higher prevalence of chronic obstructive pulmonary disease—highlighting the importance of systemic illness and comorbidity burden in thrombotic risk.
Cardiovascular survival did not differ markedly between those with and without VTE (log-rank p = 0.52; adjusted HR 0.76), suggesting that VTE occurrence did not independently worsen long-term survival in this cohort. These findings emphasize that VTE in HF is a clinically significant but phenotype-independent complication, reinforcing the requisition for individualized risk stratification, early detection, and targeted prevention strategies in cardiology, internal medicine, and emergency care settings.
Internal and Emergency Medicine
Venous thromboembolism in heart failure: incidence, phenotype-specific risk, and predictors in a large real-world cohort
Lama Alfehaid et al.
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