Sex differences in risk of incident venous thromboembolism in heart failure patients.

BACKGROUND

In patients with incident heart failure, the risk of venous thromboembolism (VTE), defined as pulmonary embolism (PE) and/or deep venous thrombosis (DVT), is sparsely described, especially potential sex differences. We conducted an observational study to evaluate risk of VTE among male and female heart failure patients.

METHODS

Population-based cohort study of patients diagnosed with incident heart failure during 2000-2015, identified by record linkage between nationwide registries in Denmark. Using a pseudo-value approach, we calculated relative risks [RR] of VTE at 1 and 3 years of follow-up. Crude VTE risk for males and females are reported and contrasted after adjustment for established clinical risk factors for VTE.

RESULTS

A total of 32,330 heart failure patients were included, of which 15,238 (47%) were females. For the combined endpoint of VTE, female sex was associated with a higher risk (1-year adjusted RR: 1.30, 95% confidence interval [CI]: 0.97-1.73; 3-year adjusted RR: 1.34, 95% CI: 1.07-1.67) compared to male patients. For the individual endpoints of PE and DVT after 1-year of follow-up, female sex was only associated with a higher risk of PE and not DVT, compared to male patients. However, female sex was associated with a higher risk of both PE and DVT after 3 years of follow-up.

CONCLUSIONS

Among incident heart failure patients, female sex is associated with a higher risk of VTE, mainly driven by an excess risk of PE. This finding may help improve clinical decision-making regarding VTE prophylaxis in patients with heart failure.