Cargando…

Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population

The role of inferior vena cava filter (IVC) filters for prevention of pulmonary embolism (PE) is controversial. This study evaluated outcomes of IVC filter placement in a managed care population. This retrospective cohort study evaluated data for individuals with Humana healthcare coverage 2013–2014...

Descripción completa

Detalles Bibliográficos
Autores principales: Everhart, Damian, Vaccaro, Jamieson, Worley, Karen, Rogstad, Teresa L., Seleznick, Mitchel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522518/
https://www.ncbi.nlm.nih.gov/pubmed/28550629
http://dx.doi.org/10.1007/s11239-017-1507-z
_version_ 1783252187156054016
author Everhart, Damian
Vaccaro, Jamieson
Worley, Karen
Rogstad, Teresa L.
Seleznick, Mitchel
author_facet Everhart, Damian
Vaccaro, Jamieson
Worley, Karen
Rogstad, Teresa L.
Seleznick, Mitchel
author_sort Everhart, Damian
collection PubMed
description The role of inferior vena cava filter (IVC) filters for prevention of pulmonary embolism (PE) is controversial. This study evaluated outcomes of IVC filter placement in a managed care population. This retrospective cohort study evaluated data for individuals with Humana healthcare coverage 2013–2014. The study population included 435 recipients of prophylactic IVC filters, 4376 recipients of therapeutic filters, and two control groups, each matched to filter recipients. Patients were followed for up to 2 years. Post-index anticoagulant use, mortality, filter removal, device-related complications, and all-cause utilization. Adjusted regression analyses showed a positive association between filter placement and anticoagulant use at 3 months: odds ratio (ORs) 3.403 (95% CI 1.912–6.059), prophylactic; OR, 1.356 (95% CI 1.164–1.58), therapeutic. Filters were removed in 15.67% of prophylactic and 5.69% of therapeutic filter cases. Complication rates were higher with prophylactic procedures than with therapeutic procedures and typically exceeded 2% in the prophylactic group. Each form of filter placement was associated with increases in all-cause hospitalization (regression coefficient 0.295 [95% CI 0.093–0.498], prophylactic; 0.673 [95% CI 0.547–0.798], therapeutic) and readmissions (OR 2.444 [95% CI 1.298–4.602], prophylactic; 2.074 [95% CI 1.644–2.616], therapeutic). IVC filter placement in this managed care population was associated with increased use of anticoagulants and greater healthcare utilization compared to controls, low rates of retrieval, and notable rates of device-related complications, with effects especially pronounced in assessments of prophylactic filters. These findings underscore the need for appropriate use of IVC filters. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11239-017-1507-z) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5522518
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Springer US
record_format MEDLINE/PubMed
spelling pubmed-55225182017-08-07 Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population Everhart, Damian Vaccaro, Jamieson Worley, Karen Rogstad, Teresa L. Seleznick, Mitchel J Thromb Thrombolysis Article The role of inferior vena cava filter (IVC) filters for prevention of pulmonary embolism (PE) is controversial. This study evaluated outcomes of IVC filter placement in a managed care population. This retrospective cohort study evaluated data for individuals with Humana healthcare coverage 2013–2014. The study population included 435 recipients of prophylactic IVC filters, 4376 recipients of therapeutic filters, and two control groups, each matched to filter recipients. Patients were followed for up to 2 years. Post-index anticoagulant use, mortality, filter removal, device-related complications, and all-cause utilization. Adjusted regression analyses showed a positive association between filter placement and anticoagulant use at 3 months: odds ratio (ORs) 3.403 (95% CI 1.912–6.059), prophylactic; OR, 1.356 (95% CI 1.164–1.58), therapeutic. Filters were removed in 15.67% of prophylactic and 5.69% of therapeutic filter cases. Complication rates were higher with prophylactic procedures than with therapeutic procedures and typically exceeded 2% in the prophylactic group. Each form of filter placement was associated with increases in all-cause hospitalization (regression coefficient 0.295 [95% CI 0.093–0.498], prophylactic; 0.673 [95% CI 0.547–0.798], therapeutic) and readmissions (OR 2.444 [95% CI 1.298–4.602], prophylactic; 2.074 [95% CI 1.644–2.616], therapeutic). IVC filter placement in this managed care population was associated with increased use of anticoagulants and greater healthcare utilization compared to controls, low rates of retrieval, and notable rates of device-related complications, with effects especially pronounced in assessments of prophylactic filters. These findings underscore the need for appropriate use of IVC filters. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11239-017-1507-z) contains supplementary material, which is available to authorized users. Springer US 2017-05-26 2017 /pmc/articles/PMC5522518/ /pubmed/28550629 http://dx.doi.org/10.1007/s11239-017-1507-z Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Article
Everhart, Damian
Vaccaro, Jamieson
Worley, Karen
Rogstad, Teresa L.
Seleznick, Mitchel
Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population
title Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population
title_full Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population
title_fullStr Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population
title_full_unstemmed Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population
title_short Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population
title_sort retrospective analysis of outcomes following inferior vena cava (ivc) filter placement in a managed care population
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522518/
https://www.ncbi.nlm.nih.gov/pubmed/28550629
http://dx.doi.org/10.1007/s11239-017-1507-z
work_keys_str_mv AT everhartdamian retrospectiveanalysisofoutcomesfollowinginferiorvenacavaivcfilterplacementinamanagedcarepopulation
AT vaccarojamieson retrospectiveanalysisofoutcomesfollowinginferiorvenacavaivcfilterplacementinamanagedcarepopulation
AT worleykaren retrospectiveanalysisofoutcomesfollowinginferiorvenacavaivcfilterplacementinamanagedcarepopulation
AT rogstadteresal retrospectiveanalysisofoutcomesfollowinginferiorvenacavaivcfilterplacementinamanagedcarepopulation
AT seleznickmitchel retrospectiveanalysisofoutcomesfollowinginferiorvenacavaivcfilterplacementinamanagedcarepopulation