Venous thromboembolism in heart failure: incidence, phenotype-specific risk, and predictors in a large real-world...

Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is a clinically important complication in patients with heart failure. Despite its relevance to internal and emergency medicine practice, contemporary real-world data examining venous thromboembolism across heart failure phenotypes remain limited.

To determine the incidence of venous thromboembolism among adults with newly diagnosed heart failure and to identify independent clinical and laboratory predictors.

This retrospective cohort study included adults diagnosed with heart failure at a tertiary medical center between 2017 and 2024. Heart failure was categorized into reduced, preserved, mildly reduced, and improved ejection fraction phenotypes. Patients receiving chronic anticoagulation or with major prothrombotic disorders were excluded. Incident venous thromboembolism events occurring in both inpatient and outpatient settings were identified during longitudinal follow-up after heart failure diagnosis. Predictors were evaluated using multivariable logistic regression and Cox proportional hazards modeling.

Among 4,211 patients followed for a median of 6.2 years (IQR: 4.6-7.5 years), 256 (6.1%) developed venous thromboembolism. Crude incidence varied by phenotype, with higher rates observed in preserved ejection fraction (7.4%; 142/1,930) than in reduced ejection fraction (4.6%; 74/1,618). However, heart failure phenotype was not independently associated with venous thromboembolism after multivariable adjustment. Patients with venous thromboembolism were older and had lower serum albumin, lower hemoglobin, more impaired kidney function, and a higher prevalence of chronic obstructive pulmonary disease. Cardiovascular survival analysis demonstrated no significant difference between venous thromboembolism and non-venous thromboembolism groups in either unadjusted (log-rank p = 0.52) or adjusted models (HR: 0.76, 95% CI: 0.30-1.93, p = 0.57).

Venous thromboembolism is a frequent and clinically significant complication in patients with heart failure. After adjustment, venous thromboembolism risk was driven by patient-level clinical and laboratory factors rather than heart failure phenotype. These findings support vigilant monitoring and individualized risk stratification in internal medicine and emergency care settings.