Long-Term Association of Venous Thromboembolism With Frailty, Physical Functioning, and Quality of Life: The Atherosclerosis Risk in Communities Study

Abstract

Background Relatively little is known about the long-term consequences of venous thromboembolism (VTE) on physical functioning. We compared long-term frailty status, physical function, and quality of life among survivors of VTE with survivors of coronary heart disease (CHD) and stroke, and with those without these diseases. Methods and Results Cases of VTE, CHD, and stroke were continuously identified since ARIC (Atherosclerosis Risk in Communities Study) recruitment during 1987 to 1989. Functional measures were objectively captured at ARIC clinic visits 5 (2011-2013) and 6 (2016-2017); quality of life was self-reported. The 6161 participants at visit 5 were, on average, 75.7 (range, 66-90) years of age. By visit 5, 3.2% had had a VTE, 6.9% CHD, and 3.4% stroke. Compared with those without any of these conditions, VTE survivors were more likely to be frail (odds ratio [OR], 3.11; 95% CI, 1.80-5.36) and have low (<10) versus good scores on the Short Physical Performance Battery (OR, 3.59; 95% CI, 2.36-5.47). They also had slower gait speed, less endurance, and lower physical quality of life. VTE survivors were similar to coronary heart disease and stroke survivors on categorical frailty and outcomes on Short Physical Performance Battery assessment. When score on the Short Physical Performance Battery instrument was modeled continuously, VTE survivors performed better than stroke survivors but worse than CHD survivors. Conclusions VTE survivors had triple the odds of frailty and poorer physical function than those without the vascular diseases considered. Their function was somewhat worse than that of CHD survivors, but better than stroke survivors. These findings suggest that VTE patients may benefit from additional efforts to improve postevent physical functioning.

Keywords: frailty; physical function; quality of life; venous thromboembolism.

Figure 1. Linear regression of prevalent VTE events with gait speed and endurance in the Atherosclerosis Risk in Communities Study, 2011–2013 and 2016–2017.

A, Gait speed—4‐m walk (in meters per second). B, Endurance (in feet). CHD indicates coronary heart disease; and VTE, venous thromboembolism.

Figure 2. Polytomous logistic regression of prevalent VTE with Short Physical Performance Battery score and frailty in the Atherosclerosis Risk in Communities Study, 2011–2013.

A, SPPB score. B, Frailty. CHD indicates coronary heart disease; and VTE, venous thromboembolism.