In the Journals

Inferior vena cava filter use does not lower mortality in PE

Older patients with pulmonary embolism who received an inferior vena cava filter demonstrated higher rates of 30-day and 1-year mortality, according to findings published in JAMA Internal Medicine.

“Acute PE is a common cause of morbidity and mortality in older adults,” Behnood Bikdeli, MD, from the division of cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, and colleagues wrote. “Inferior vena cava filters are frequently used to prevent subsequent PE; nearly one in six of elderly Medicare fee-for-service beneficiaries with PE received an inferior vena cava filter. However, the evidence supporting device efficacy and safety is scant.”

Bikdeli and colleagues conducted a study to investigate whether inferior vena cava filters lower mortality rates in Medicare fee-for-service beneficiaries with PE.

The researchers identified 214,579 older fee-for-service beneficiaries (57.4% women; 84.9% white; mean age, 77.8 years) hospitalized for acute PE between 2011 and 2014. About 13% of these patients received an inferior vena cava filter. Participants were matched based on patient characteristics, such as demographics and comorbidities. The matched cohort included 76,198 fee-for-service beneficiaries hospitalized with acute PE, including 18.2% who received an inferior vena cava filter.

Results showed that the 30-day mortality rate was higher among participants receiving an inferior vena cava filter compared with those who did not (11.6% vs. 9.3%; adjusted OR = 1.02; 95% CI, 0.98-1.06). In an analysis using a stabilized inverse probability weighting approach, these findings were statistically significant (OR = 1.16; 95% CI, 1.12-1.21).

In patients who survived longer than 30 days after admission, the 1-year mortality rate was 20.5% for those in the inferior vena cava filter group and 13.4% for those in the control group. When adjusting for patient characteristics, the OR was 1.35 (95% CI, 1.31-1.4). When using the inverse probability weighting approach, the adjusted OR was 1.56 (95% CI, 1.52-1.61).

In mixed models that used inferior vena cava filter as the dependent variable, patients who received an inferior vena cava filter had greater odds for 30-day mortality (OR = 1.61; 95% CI, 1.5-1.73) and 1-year mortality (OR = 2.19; 95% CI, 2.06-2.33) than those who did not receive a filter.

“Our study ... does not suggest an association between inferior vena cava filter use and lower mortality rates,” Bikdeli and colleagues concluded. “These findings stand in contrast with prior reports from administrative databases that suggested efficacy of inferior vena cava filters but did limited adjustment for potential confounders. Instead, our study showed hypothesis-generating findings for increased risk.”

“These findings in combination with the paucity of evidence from trials raise concerns about the widespread use of these inferior vena cava filters,” they added. “There is a need for more and better studies (randomized clinical trials or prospective controlled observational studies) to test the efficacy and safety of inferior vena cava filters across various patient subgroups.” – by Alaina Tedesco

 

Disclosures: Bikdeli report serving as an expert on behalf of the plaintiff in litigation related to inferior vena cava filters. Please see study for all other authors’ relevant financial disclosures.

Older patients with pulmonary embolism who received an inferior vena cava filter demonstrated higher rates of 30-day and 1-year mortality, according to findings published in JAMA Internal Medicine.

“Acute PE is a common cause of morbidity and mortality in older adults,” Behnood Bikdeli, MD, from the division of cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, and colleagues wrote. “Inferior vena cava filters are frequently used to prevent subsequent PE; nearly one in six of elderly Medicare fee-for-service beneficiaries with PE received an inferior vena cava filter. However, the evidence supporting device efficacy and safety is scant.”

Bikdeli and colleagues conducted a study to investigate whether inferior vena cava filters lower mortality rates in Medicare fee-for-service beneficiaries with PE.

The researchers identified 214,579 older fee-for-service beneficiaries (57.4% women; 84.9% white; mean age, 77.8 years) hospitalized for acute PE between 2011 and 2014. About 13% of these patients received an inferior vena cava filter. Participants were matched based on patient characteristics, such as demographics and comorbidities. The matched cohort included 76,198 fee-for-service beneficiaries hospitalized with acute PE, including 18.2% who received an inferior vena cava filter.

Results showed that the 30-day mortality rate was higher among participants receiving an inferior vena cava filter compared with those who did not (11.6% vs. 9.3%; adjusted OR = 1.02; 95% CI, 0.98-1.06). In an analysis using a stabilized inverse probability weighting approach, these findings were statistically significant (OR = 1.16; 95% CI, 1.12-1.21).

In patients who survived longer than 30 days after admission, the 1-year mortality rate was 20.5% for those in the inferior vena cava filter group and 13.4% for those in the control group. When adjusting for patient characteristics, the OR was 1.35 (95% CI, 1.31-1.4). When using the inverse probability weighting approach, the adjusted OR was 1.56 (95% CI, 1.52-1.61).

In mixed models that used inferior vena cava filter as the dependent variable, patients who received an inferior vena cava filter had greater odds for 30-day mortality (OR = 1.61; 95% CI, 1.5-1.73) and 1-year mortality (OR = 2.19; 95% CI, 2.06-2.33) than those who did not receive a filter.

“Our study ... does not suggest an association between inferior vena cava filter use and lower mortality rates,” Bikdeli and colleagues concluded. “These findings stand in contrast with prior reports from administrative databases that suggested efficacy of inferior vena cava filters but did limited adjustment for potential confounders. Instead, our study showed hypothesis-generating findings for increased risk.”

“These findings in combination with the paucity of evidence from trials raise concerns about the widespread use of these inferior vena cava filters,” they added. “There is a need for more and better studies (randomized clinical trials or prospective controlled observational studies) to test the efficacy and safety of inferior vena cava filters across various patient subgroups.” – by Alaina Tedesco

 

Disclosures: Bikdeli report serving as an expert on behalf of the plaintiff in litigation related to inferior vena cava filters. Please see study for all other authors’ relevant financial disclosures.