Blood clot facts show need for greater advocacy

clot-sum

Venous thromboembolism (VTE) is a medical condition in which a blood clot forms in a deep vein of the body.

VTE is the broad term which encompasses clots which form in a deep vein of the body and they may go by several names, depending on the location of the clot: deep vein thrombosis (DVT), pulmonary embolism (PE), sinus vein thrombosis (SVT), cerebral vein thrombosis(CVT), portal vein thrombosis (PVT), mesenteric vein thrombosis (MVT).

Public health scope of VTE

“Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) represent a major public health problem, exacting a significant human and economic toll on the Nation.”-US Surgeon General 2008 Call to Action

VTE is a leading cause of death and disability:

  • Over 900,000 Americans have a VTE event each year and it causes more deaths than breast cancer, AIDS and car crashes combined.[1],[2]
  • VTE is the third leading cause of death, but is not widely known because VTE is excluded from CDC Vital Statistic reports which reflect only 113 select causes of death.[3]
  • Upwards of a third of VTE patients die within one month of diagnosis.[4]
  • Even with optimal medical care, half of VTE patients will have long-term complications and one-third will have a recurrent clot within 10 years.[5]
  • VTE is the leading cause of preventable hospital deaths in the United States. ~60% of VTE are associated with hospitalization.[6]
  • VTE is the leading cause of maternal death in the United States.[7]
  • An estimated $7-12 billion in medical costs in the US each year can be attributed to DVT and PE.[8]
  • High levels of anxiety, depression and psychological stress have been reported among patients with VTE.[9]

Funding

By comparison to other better known conditions:

  • AIDS funding = $31.7 billion[11], CDC portion of AIDS funding = $927.8 million10
  • Breast & cervical cancer funding (in 1 combined line-item), CDC = $169 million

Learn more


My Suggestions on Federal Action Needed to Change These Statistics

To target VTE, the President and Congress need to:

  1. Establish a task force (as has been done for other conditions)  to review, consolidate and coordinate all US VTE efforts across federal agency stakeholders–CDC, CMS, AHRQ, NIH, FDA, HRSA, Veterans Affairs, Rural Health.  Currently, efforts are siloed reflecting a lack of cross-agency collaboration.
  2. Make a clearly named VTE line-item funding allocation.
    1. Funds should carry the mandate that they can only be utilized for VTE, prohibiting the ability to divert funds towards other conditions.
  3. A clear line of reporting and accountability should be implemented with attached funds to ensure results.
    1. If it is determined that CDC should maintain responsibility for public health prevention of VTE, then a clearly named VTE line-item funding allocation must be made within the same CDC administrative unit that addresses other thrombotic conditions–the National Center for Chronic Disease Prevention and Health Promotion.  If another agency is chosen, VTE should be paired with related thrombotic conditions to take advantage of existing expertise.
  4. Require HHS/CDC to update the National Vital Statistics reporting to add VTE to the current list of 113 select causes of death.  Neither the public nor Congress can be aware of the true scope of a condition which is not reported.

 

 

REFERENCES

[1] CDC Statistics on DVT/PE (VTE) http://www.cdc.gov/ncbddd/dvt/data.html

[2] 2008 Surgeon General Call to Action report http://www.ncbi.nlm.nih.gov/books/NBK44178/pdf/Bookshelf_NBK44178.pdf

[3] Selective statistics diminish VTE burden https://bethwaldron.com/selective-statistics-diminish-vte-burden/

[4] CDC Data and Statistics, DVT/PE, 12/4/2015 http://www.cdc.gov/ncbddd/dvt/data.html

[5] Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern.Am J Prev Med. 2010 Apr;38(4 Suppl):S495-501.  http://www.ncbi.nlm.nih.gov/pubmed/20331949

[6] AHRQ, Preventing Hospital Associated Venous Thromboembolism: A Guide for Effective Quality Improvement, October 2015, Publication: 16-0001-EF  http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/vtguide/index.html and Greg Maynard, Venous Thromboembolism (VTE) Prevention in the Hospital (Text Descript: Slide Presentation. June 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/vtepresentation/maynardtxt.html

[7] Berg CJ, Atrash HK, Koonin LM, Tucker M. “Pregnancy-related mortality in the United States 1987-1990”. Obstet Gynecol 1996;88(2):161-7 Also see Marik. P.E. and Plante, L.A. “Venous Thromboembolic Disease and Pregnancy”. New England Journal of Medicine, volume 359, number 19, November 6, 2008, pages 2025-2033.

[8] Gross, Scott et al The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs, Thrombosis Research, November 24, 2015,  http://www.thrombosisresearch.com/article/S0049-3848(15)30209-7/abstract

[9] Simon Noble “Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study” BMJ Open http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987719/

[10] CDC FY 2016 budget http://www.cdc.gov/fmo/topic/Budget%20Information/appropriations_budget_form_pdf/FY2016_CDC_CJ_FINAL.pdf

CDC FY 2017 Request http://www.cdc.gov/budget/fy2017/congressional-justification.html

[11] Kaiser Family Foundation U.S. Federal Funding for HIV/AIDS: The President’s FY 2016 Budget Request

Apr 13, 2015 http://kff.org/global-health-policy/fact-sheet/u-s-federal-funding-for-hivaids-the-presidents-fy-2016-budget-request/#footnote-148589-1

Leave a Reply

Name and email address are required. Your email address will not be published.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

You may use these HTML tags and attributes:

<a href="" title="" rel=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <pre> <q cite=""> <s> <strike> <strong> 

%d bloggers like this: