Venous thromboembolism: Under-recognized and under-treated

September 22, 2007 By Grendel Burrell [mailto:grendel.burrell@gmail.com]

Washington, DC: United by a mission to increase public and health professional awareness of venous disease, the Venous Disease Coalition (VDC) is a public and interdisciplinary consortium dedicated to promoting public and health professional awareness of venous disease, the management and consequences of the disease. Comprised of a network of leading health care professionals and non-profit organizations, the Venous Disease Coalition hosted a press conference on September 18 at the National Press Club in Washington DC to kick off their efforts. Presenters included the Congressional representative of the Colorado district in which the VDC office is located, Ed Perlmutter, to an executive who experienced deep vein thrombosis and two episodes of pulmonary embolism, Mike Hefron, to a deputy director of the NHLBI, Dr. Susan Shurin, to researchers, and physicians. All presented strong messages about the critical importance of changing the course of awareness and treatment of under-recognized and under-treated venous diseases including deep vein thrombosis and pulmonary embolism. Also emphasized was the importance of patient awareness and patient advocacy for preventive approaches.

Serving as chair of the VDC is Dr. Samuel Z. Goldhaber, the Director of the Brigham and Women’s Hospital Venous Thromboembolism Research Group and a long term advocate of prevent and treatment of venous thromboembolism. Dr. Goldhaber has a long history in the clinical investigation of therapies in this area. Unfortunately, a bout of flu kept him from participating in the press conference.

Dr. Robert McLafferty, a professor in the Division of Vascular Surgery at Southern Illinois University School of Medicine and Dr. Suresh Vedantham, an interventional radiologist and Associate Professor of Radiology and Surgery at Washington University School of Medicine delivered the statistics and shared the goals of the Coalition. They told the audience that it is imperative that healthcare professions recognize at risk patients- those with recent surgery, leg injury or major bodily injury, those admitted to the hospital for medical illness and cancer patients. Without active efforts to prevent VTE, it will develop in 10-20% of medical patients and 30-50% of surgical patients. In the US alone, approximately 1 million people die every year as a consequence of VTE. 300,000 die of pulmonary embolism every year, and deaths from pulmonary embolism are five times more common than the combined deaths from breast cancer, car accidents, and AIDS.

The Vascular Disease Foundation is a driving force in the creation of this unique coalition to partner with 19 other major national public health organizations and professional societies include the American College of Cardiology, American College of Chest Physicians, American Society of Hematology, North American Thrombosis Forum, Society of Critical Care Medicine, Society of Interventional Radiology, Society of Vascular Medicine, nursing organizations, physician assistant organizations, and various networks and forums with interest in venous thromboembolism.

In a related article recently published in Circulation, Alan Hirsch, MD, University of Minnesota, Minneapolis and co authors for the Peripheral Artery Disease Coalition published the results of a large survey about awareness of peripheral artery disease. PAD itself affects almost 9 million Americans and Canadians alone (1) and confers a fivefold increased relative risk of MI and a two to three fold greater risk of stroke and total mortality (2). Thus, the Peripheral Arterial Disease (PAD) Coalition has formed an alliance of leading health organizations, vascular health professional societies and government agencies united around a common purpose—to raise public and health professional awareness about lower extremity P.A.D (http://www.padcoalition.org).

The PAD Coalition conducted a cross-sectional, population-based telephone survey of a nationally representative sample of 2501 adults >50 years of age to establish a baseline for knowledge of the disease. 46.5% were male. 53.5% had completed high school or more education. 59.8% had an income < $55,000. The survey instrument assessed the study population for the demographic, risk factor, and cardiovascular disease characteristics, prevalence of leg symptoms, awareness of PAD relative to atherosclerosis risk factors and other cardiovascular and non-cardiovascular diseases, understanding of the causes of PAD, and perceived systemic and limb consequences of PAD. Study participants were 67.2+/-12.6 years of age with a high prevalence of risk factors but only a modest burden of known coronary or cerebrovascular disease (3).

There was little difference in the knowledge base between males and females except that more women were aware that atherosclerosis is a risk factor for PAD. Survey participants ≥ 70 years were generally less knowledgeable in all categories measured. 25% of all respondents expressed familiarity with PAD, and this rate was significantly lower than that for any other cardiovascular disease or atherosclerosis risk factor. Within the "PAD-aware" cohort, half of the individuals were not aware that diabetes and smoking increase the risk for PAD. Less than 1 in 4 survey participants knew that PAD is associated with increased risk of heart attack and stroke. 14% were aware that amputation could be a sequel of PAD.

The authors concluded that the public is poorly informed about PAD, with major knowledge gaps regarding what constitutes PAD, risk factors that lead to PAD, associated limb symptoms, and amputation risk. In addition, there is a lack of awareness that PAD provides a high short-term risk of heart attack, stroke, and death. Public PAD knowledge could be improved by national education program designed to increase knowledge of critical information about PAD. (3).

Resource for health care professionals and patients

 * http://www.VenousDiseaseCoalition.org
 * http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.725101v1
 * http://www.padcoalition.org