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Venous thromboembolism decreases physical function among women

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August 7, 2018

Women with venous thromboembolism demonstrated an acute decrease in physical function compared with women without VTE, according to study results.

“Although much research has examined quality-of-life measures after other cardiovascular outcomes, relatively little research has investigated quality of life after VTE, especially over the longer term,” Kaitlin A. Hagan, ScD, MPH, research fellow at Brigham and Women’s Hospital, and colleagues wrote. “Physical function, which is the ability to perform basic and instrumental activities of daily living, is a vital component of healthy aging and quality of life. Poor physical function is related to hospitalization, long-term nursing home care and increased mortality among older adults.”

Researchers used data from two Nurses’ Health studies to assess physical function following VTE. The analysis included an older cohort of 80,836 women aged 46 to 72 years in 1992, and a younger cohort of 84,304 women aged 29 to 48 years in 1993.

Researchers measured physical function every 4 years using the Medical Outcomes Short Form-36 physical function scale.

Patients in the older cohort had 20 years of follow-up. During that time, 2,304 women developed VTE, including 996 with deep vein thrombosis only, and 1,308 women with pulmonary embolism, with or without DVT.

In the younger cohort, researchers observed 620 women with VTE, including 323 with DVT only and 297 with PE over 8 years of follow-up.

Investigators observed a decline in physical function over 4 years among women who experienced VTE compared with those without incident VTE.

Older women with VTE experienced a 6.5-point (95% CI, 7.4 to 5.6) decrease in physical function over 4 years compared with women without VTE. Because 1 year of aging was associated with a 1.2-point decline in physical function score among older women, this decline among women with VTE was equivalent to 5.4 years of aging. The most common limitations included those that involved vigorous activities, climbing several flights of stairs, walking more than 1 mile and bending/kneeling.

VTE was associated with a 3.8-point (95% CI, 5.6 to 2) decrease in physical function every 4 years among younger women.

The decline in physical function appeared greater among women with a PE, including for older women (7.4 points; 95% CI, 8.7 to 6.1) and younger women (4.8 points; 95% CI, 6.8 to 2.8). The physical decline appeared equivalent to 6.2 years of aging among older women.

Results showed similar long-term slopes of physical function decline among women who did and did not have a VTE. However, the absolute level of physical function appeared worse among those with VTE at the end of follow-up.

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“In subsequent time periods after a VTE event, physical function returned to the expected rate of decline associated with aging; the steep decline occurring at the time of the VTE resulted in worse absolute physical function among women with VTE at the end of follow-up,” the researchers wrote.

The limitations of the study included the homogenous population, potential misclassification of VTE and lack of information on recurrent VTE.

“Given the importance of physical function to healthy aging and quality of life, the results of this analysis highlight the importance of both preventing VTE and intervening early after VTE diagnosis to improve long-term health outcomes,” the researchers wrote. – by Cassie Homer

Disclosures: Hagan reports no relevant financial disclosures. One author reports grants from Diagnostica Stago, Janssen and Siemens Healthcare Diagnostics.