Small-Area Analysis of Treatment and Clinical Outcomes in Patients with Venous Thromboembolism in Denmark: A Nationwide Cohort Study.

Autor:	Johnsen SP; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark., Jensen M; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.; Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark., Münster AM; Unit for Thrombosis Research, Hospital of South West Jutland, Esbjerg, Denmark., Frost L; Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark., Harboe L; Bristol Myers Squibb, Copenhagen, Denmark., Poulsen PB; Pfizer, Copenhagen, Denmark., Albertsen IE; Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark.; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Vinter N; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.; Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark., Grove EL; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Larsen TB; Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark.; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Jazyk:	angličtina
Zdroj:	Thrombosis and haemostasis [Thromb Haemost] 2023 Oct; Vol. 123 (10), pp. 978-988. Date of Electronic Publication: 2023 Apr 13.
DOI:	10.1055/a-2073-4336
Abstrakt:	Objectives:  To investigate geographical variation in initiation and extended treatment with anticoagulants and clinical outcomes among patients hospitalized with first-time venous thromboembolism (VTE) in Denmark between 2007 and 2018. Methods:  Using nationwide health care registries, we identified all patients with a first-time VTE hospital diagnosis supported by imaging data from 2007 to 2018. Patients were grouped according to residential region (5) and municipality (98) at the time of VTE diagnosis. Cumulative incidence of initiation of and extended (beyond 365 days) anticoagulation treatment as well as clinical outcomes, including recurrent VTE, major bleeding, and all-cause death, were assessed. Sex- and age-adjusted relative risks (RRs) of the outcomes were computed when comparing across individual regions and municipalities. Overall geographic variation was quantified by computing the median RR. Results:  We identified 66,840 patients with a first-time VTE hospitalization. A difference in initiation of anticoagulation treatment of more than 20 percentage points between regions was observed (range: 51.9-72.4%, median RR: 1.09, 95% confidence interval [CI]: 1.04-1.13). Variation was also observed for extended treatment (range: 34.2-46.9%, median RR: 1.08, 95% CI: 1.02-1.14). The cumulative incidence of recurrent VTE ranged from 3.6 to 5.3% at 1 year (median RR: 1.08, 95% CI: 1.01-1.15). The difference remained after 5 years, and variation was also observed for major bleeding (median RR: 1.09, 95% CI: 1.03-1.15), whereas it appeared smaller for all-cause mortality (median RR: 1.03, 95% CI: 1.01-1.05). Conclusion:  Substantial geographical variation in anticoagulation treatment and clinical outcomes occurs in Denmark. These findings indicate a need for initiatives to ensure uniform high-quality care for all VTE patients. Competing Interests: S.P.J. has received research grants from Bristol Myers Squibb and Pfizer and received consultancy fees from Bristol Myers Squibb and Pfizer. A.M.M. has received speaker honoraria from Bayer, Bristol Myers Squibb, Pfizer, Boehringer Ingelheim, MSD, and Astra Zeneca. E.L.G. has received speaker honoraria or consultancy fees from AstraZeneca, Alexion Pharma, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Lundbeck Pharma, MSD, MundiPharma, Organon, and Pfizer. He is an investigator in clinical studies sponsored by AstraZeneca and Bayer and has received unrestricted research grants from Boehringer Ingelheim. L.H. is an employee at Bristol Myers Squibb. P.B.P. is an employee at Pfizer. L.F. is supported by the Health Research Foundation of Central Denmark Regions and has received speaker honoraria and consultancy fees from Pfizer. I.E.A. has received speaker fees from Pfizer and Bayer AG. M.J. and N.V. have no conflicts of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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