Embed Size (px)
Citation preview
Venous Thromboembolism (VTE)
A patient safety issue from a patient perspective
Beth Waldron, MAProgram Director, Clot Connect
University of North Carolina at Chapel Hill
April 16, 2012NCD HENS Partnership for Patients Webinar
Disclosures
Beth WaldronNone
Clot Connect ProgramCooperative Agreement with CDCEducational charitable donations by
Talecris Biotherapeutics NC Cancer Hospital Endowment Fund
Agenda
1. VTE background2. Patient story3. VTE prevention in hospital setting4. VTE resources5. Discussion
Terminology
Deep Vein Thrombosis (DVT): Clot that has formed in the deep veins of
the body, also called Deep Vein Thrombosis, or DVT
While DVT can occur anywhere in the body, it is most common in the leg.
Pulmonary Embolism (PE): Clot in the pulmonary vessels, often
referred to as PE. PE occurs when a blood clot breaks off from
a DVT, travels through the blood stream and lodges in the lung.
Potentially life-threatening complication of DVT.
Venous Thromboembolism (VTE): DVT + PE are collectively known as VTE
Who is at increased risk for VTE?
A. 70 year old man in good general health
B. 40 year old athletic man having knee surgery
C. 30 year old cancer patient on chemotherapy
D. 20 year old healthy pregnant woman
E. None of the above
F. All of the above
QUESTION:
Factors which increase VTE risk Immobility (during hospitalization, recovery at home) Major surgery (abdomen, pelvis, hip, knee) Bone fracture or cast Central venous catheter Increased estrogen (birth control pill/patch/ring, pregnancy, hormone
therapy) Certain medical conditions (cancer and its treatment, heart failure,
inflammatory disorders) History of VTE; family history of VTE Clotting disorder (thrombophilia) Obesity Smoking Age
95% of hospital patients = at risk 31% of hospital patients = moderate to high risk
Anderson et al. 2007 AHRQ HCUP Discharge data
* multiplicative risk
Approximately 300,000-600,000 Americans develop VTE each year. 1
60,000-100,000 die each year from VTE. Many deaths from PE go undiagnosed. Actual figure may be higher.
40% of all VTE are associated with hospitalization 2 occurring either in the hospital or shortly after discharge
VTE is one of the leading preventable causes of hospital death 3
40% or more of hospital associated VTE is preventable through prophylaxis 4
VTE: A patient safety issue
Sources: 1 CDC2 Heit 20123 AHRQ 4 PfP
VTE: Not a benign event for patients and family
Sudden death occurs in 25% of patients with pulmonary embolism 1
Post-thrombotic syndrome (PTS) Occurs in 40-50% of DVT survivors 2
Characterized by chronic swelling, pain, decreased mobility, ulceration
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Occurs in 4% of PE survivors 3
Characterized by persistent shortness of breath, particularly with exercise, which can lead to right-side heart failure
High levels of anxiety, depression and psychological stress have been reported among VTE patients 4
Sources:1 CDC2 Ashrani/Heit 2009; Kahn et al 20083 Pengo et al. 20044 Lui et al 2011; Lukas et al 2009
VTE: Not a benign event for hospitals or society Estimates:
$10 billion in medical costs each year due to VTE (United States) 1
Total medical cost per DVT per patient per year = $19,800 (US 2010)2
Among health plan members with a first time VTE hospitalization, 25% had hospital readmission with an average cost of $15,000 3
Appropriate prophylaxis can reduce hospital costs by as much as $2,000 per high risk patient 4
Sources: 1 CDC-NCBDDD Strategic Plan 20112 Mahan et al. 20113 Spyropoulos & Lin 20074 Amin et al 2011
A patient’s clotting story…my story
2003, 34 years old, married, 1 child:
Diagnosed with DVT and bilateral PE
Prior to clotting episode: Excellent health No notable medical conditions No recent travel, surgery, or hospitalization Medications: recently restarted oral
contraceptives following 4 year break
Mike, Beth & Evan Waldron
My story: Missed opportunities for diagnosis
Symptoms: Initial diagnosis:
Leg pain pulled muscle
Chest pain+ respiratory infection - prescribed antibiotics Rapid heart rate+ Shortness of breath
Result: Leading to:
Second PE episode 9 day hospitalizationsurgical placement of inferior vena cava filterinitiation of anticoagulant therapy
IV heparinSubcutaneous low-molecular weight heparinwarfarin (Coumadin®)
Symptoms of VTE can mimic other less serious conditions, delaying accurate diagnosis
My story: Outcome
My risk factors for clotting at the time of diagnosis:
Genetic thrombophilia identified (homozygous Factor V Leiden mutation) Oral contraceptives ? ??? multiplicative risk
Today:
Long-term anticoagulant therapy No new clots Mild post-thrombotic syndrome Lifelong worry of recurrence
Motivated to prevent and reduce burden of VTE!!
Story Takeaway:
From the patient perspective, VTE is a major event
For VTE survivors: Risks associated with anticoagulant use, bleeding risk Burden of anticoagulation, management/monitoring Pain management Mobility concerns Development of post-thrombotic disorders, possible disability Higher risk for clot recurrence Psychological effects associated with a life-threatening and
lifestyle-altering medical condition Cost of care: both short-term acute management and long-term
follow-up care
Prevention, prevention, prevention!!! If you prevent the VTE, you prevent the negative outcomes.
VTE Prevention
Much is known about how to prevent VTE, but that knowledge is not being applied in a consistent, systemic way.
Guidelines for Hospital Prevention of VTE:American College of Chest Physicians (ACCP) 9th edition, 2012American College of Physicians (ACP) November 2011American Academy of Orthopedic Surgeons (AAOS), September 2011American College of Obstetricians and Gynecologists (ACOG), September 2011American Society of Clinical Oncology (ASCO) 2007National Comprehensive Cancer Network (NCCN) 2010
VTE risk assessment prophylaxis Pharmacologic – anticoagulant Mechanical - compression device, graduated compression stockings
Weighing VTE risk with bleeding risk associated with anticoagulants
Challenges in reducing hospital associated VTE:
Limited use of prophylaxisProphylaxis may be given too late, for too short a duration, or
in less than optimal dose or form Inconsistent application of guidelinesVariance by facility, provider specialty, individual physician,
surgical procedure, inpatient/outpatient, medical/surgical
A need exists for:
1. Standardized VTE risk assessment2. Adherence to standards3. Consistent application of policies, VTE prevention measures4. Health care professionals fully engaged in VTE prevention at their
hospital. Knowledge: understand the impact it has on patient safety and
optimal health outcomes Empowerment: provided the tools and resources to have impact
Clot Connect initiatives are targeted at: Persons who have experienced VTE Persons at high risk for developing VTE Health care professionals
Outreach initiative at the University of North Carolina in Chapel Hill
Mission: to increase knowledge of VTE, thrombophilia and anticoagulation by providing education and support resources for patients and health care professionals
VTE Resource
.org
www.ClotConnect.org
Education materials, videos, webinars Education blog answering common questions and concerns Online support forum Monthly newsletter
For Patients…
www.ClotConnect.org
For Health Care Professionals…Access to clinical care guidelinesPatient handout materialsEducation blog to assist with clinical care and anticoagulation managementMonthly newsletter
www.ClotConnect.org
SummaryVTE: A patient safety issue from a patient perspective
VTE is a major patient safety issue.VTE can occur in anyone, at any age. VTE is not a benign medical event---impact on patients and hospitals.VTE can be prevented.
40% or more of VTE is preventable through prophylaxis.
Key to reducing hospital-associated VTE:
Vigilance to consistently assess all hospitalized patients for VTE risk and implement proper prophylaxis measures.
Key to reduce complications of VTE:
Patients should be aware of the symptoms of DVT and PE and know what to do/who to call should symptoms arise following discharge.
Contact information:
Beth WaldronProgram Director, Clot ConnectUniversity of North Carolina at Chapel HillCB 7305170 Manning Dr-3185K Physician Office BuildingChapel Hill, NC [email protected]
www.ClotConnect.org
