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

Background: Because reported survival after venous thromboembolism (VTE) va ries widely, we performed a population-based retrospective cohort study to estimate survival, compare observed with expected survival, and determine p redictors of short-term (less than or equal to 7 days) and long-term surviv al (>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) for ward 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 +/- D VT, 59.1%), 72.0% (DVT, 94.5%; PE +/- DVT, 55.6%), and 63.6% (DVT, 85.4%; P E +/- DVT, 47.7%), respectively. Observed survival after DVT, PE +/- DVT, a nd overall was significantly worse than expected for Minnesota whites of si milar 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 s urvival improved during the 25-year study period, while longterm survival w as unchanged. After adjusting for comorbid conditions, PE +/- DVT was an in dependent predictor of reduced survival for up to 3 months after onset comp ared with DVT alone. Other independent predictors of both short- and long-t erm survival included age, body mass index, patient location at onset, mali gnancy, 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 chr onic renal disease. Conclusions: Survival after VTE, and especially after PE +/- DVT, is much w orse than reported, and significantly less than expected survival. Compared with DVT alone, symptomatic PE +/- DVT is an independent predictor of redu ced survival for up to 3 months after onset, implying that treatment for th e 2 disorders should be different.