Incidence and risk factors of pulmonary hypertension after venous thromboembolism: An analysis of a large healthcare database

Background Pulmonary hypertension (PH) is a devastating potential complication of pulmonary embolism (PE), a manifestation of venous thromboembolism (VTE). The incidence of and risk factors for PH in those with prior VTE is poorly characterized. Methods ICD codes from inpatient and outpatient medical claims from MarketScan administrative databases for years 2011-2018 were used were used to identify cases of VTE, comorbidities prior to the VTE event, and PH occurring subsequent to the VTE event. Cumulative incidence and hazard ratios (HR), and their 95% confidence intervals (CI), were calculated. Results The 170,021 VTE cases included in the analysis were on average (± SD) 57.5 ± 15.8 years old and 50.5% were female. A total of 5,946 PH cases accrued over an average follow-up of 1.94 years. Two years after incident VTE the cumulative incidence (95% CI) of PH was 3.5% (3.4%, 3.7%) overall. It was higher among women [3.9% (3.8%-4.1%)] than men [3.2% (3.0%-3.3%)], and among patients presenting with PE [6.2% (6.0%-6.5%)] than those presenting with deep vein thrombosis-only [1.1% (1.0%-1.2%)]. Adjusting for age and sex, risk of PH was higher among VTE patients with underlying comorbidities. The strongest associations were observed with concomitant heart failure [HR: 2.17 (1.04-2.31)], chronic pulmonary disease [2.01 (1.90-2.14)], and myocardial infarction [1.53 (1.40-1.67)]. Conclusions In this large real-world population of insured people with VTE, 3.5% developed PH in the 2 years following their initial VTE event. Risk was higher among women, with increasing age, and in those with additional comorbidities at the time of the VTE event. These data provide insights into the burden of PH and risk factors for PH among VTE patients.