The overall aim of the proposed observational study is to continue population-based surveillance for monitoring trends in the incidence, management strategies, and recurrence and case-fatality rates associated with venous thromboembolism (VTE) in residents of a large metropolitan area. We will also perform prospective follow-up of a subset of patients diagnosed with VTE in 2009 and 2011. Despite advances in the diagnosis, prophylaxis, and treatment of this clinical syndrome, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), VTE remains a significant cause of morbidity and mortality. Based on data from our initial study, the rates of recurrence of VTE after an initial diagnosis and the rates of bleeding related to VTE treatment remain unacceptably high. It has been estimated that annual mortality from VTE in Americans exceeds that of AIDS, breast cancer, and highway fatalities combined. This surveillance project will continue the follow-up of all residents of Worcester, MA diagnosed with DVT and/or PE during our 3 previous study years (1999, 2001, and 2003) with extension to 4 new study years (2005, 2007, 2009, and 2011). The overlapping components of this community-based study have been designed to provide complementary and inclusive information about the contemporary epidemiology of VTE including incidence rates, outcomes, physician management practices, and health-related quality of life (QOL), and changes over time therein. Detailed follow-up of our prospective cohorts will allow for more in-depth analysis of the natural history of VTE, its impact on health related QOL, duration and intensity of anticoagulation therapies employed, and evaluation of long-term medical care utilization patterns. The data provided from this study will be instrumental in identifying populations of patients with VTE at high risk for adverse outcomes, improper or underutilization of specific diagnostic testing or therapies, and contemporary outcomes. This information will set the stage for the design of targeted interventions to address shortcomings in current management practices with the goal of favorably influencing the long-term outcomes of patients with VTE.

Public Health Relevance

It has been estimated that blood clots of the legs and lungs cause more deaths per year than AIDS, breast cancer, and highway fatalities combined. Data obtained from this study will allow for better estimates of the true burden of this disease in the U.S. as well as deficiencies in current management practices. This information will set the stage for future studies designed to address these shortcomings.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL070283-08
Application #
8080425
Study Section
Cardiovascular and Sleep Epidemiology (CASE)
Program Officer
Kindzelski, Andrei L
Project Start
2002-04-01
Project End
2013-05-31
Budget Start
2011-06-01
Budget End
2013-05-31
Support Year
8
Fiscal Year
2011
Total Cost
$775,863
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655
Huang, Wei; Goldberg, Robert J; Anderson, Frederick A et al. (2016) Occurrence and predictors of recurrence after a first episode of acute venous thromboembolism: population-based Worcester Venous Thromboembolism Study. J Thromb Thrombolysis 41:525-38
Makam, Raghavendra Charan P; Erskine, Nathaniel; McManus, David D et al. (2016) Decade-Long Trends (2001 to 2011) in the Use of Evidence-Based Medical Therapies at the Time of Hospital Discharge for Patients Surviving Acute Myocardial Infarction. Am J Cardiol 118:1792-1797
Huang, W; Goldberg, R J; Cohen, A T et al. (2015) Declining Long-term Risk of Adverse Events after First-time Community-presenting Venous Thromboembolism: The Population-based Worcester VTE Study (1999 to 2009). Thromb Res 135:1100-6
Huang, Wei; Goldberg, Robert J; Anderson, Frederick A et al. (2014) Secular trends in occurrence of acute venous thromboembolism: the Worcester VTE study (1985-2009). Am J Med 127:829-39.e5
Spencer, Frederick A; Gurwitz, Jerry H; Schulman, Sam et al. (2014) Venous thromboembolism in older adults: A community-based study. Am J Med 127:530-7.e3
Piazza, Gregory; Goldhaber, Samuel Z; Kroll, Aimee et al. (2014) Venous thromboembolism in patients with prior stroke. Clin Appl Thromb Hemost 20:43-9
Piazza, Gregory; Goldhaber, Samuel Z; Kroll, Aimee et al. (2012) Venous thromboembolism in patients with chronic obstructive pulmonary disease. Am J Med 125:1010-8
Spencer, Frederick A; Kroll, Aimee; Lessard, Darleen et al. (2012) Isolated calf deep vein thrombosis in the community setting: the Worcester Venous Thromboembolism study. J Thromb Thrombolysis 33:211-7
Piazza, Gregory; Goldhaber, Samuel Z; Kroll, Aimee et al. (2012) Venous thromboembolism in patients with diabetes mellitus. Am J Med 125:709-16
Parikh, Amisha M; Spencer, Frederick A; Lessard, Darleen et al. (2011) Venous thromboembolism in patients with reduced estimated GFR: a population-based perspective. Am J Kidney Dis 58:746-55

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