Intermittent pneumatic compression for venous thromboembolism prevention: a systematic review on factors affecting adherence

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Abstract

Objective

Venous thromboembolism (VTE) is a potentially fatal complication of hospitalisation. Intermittent pneumatic compression (IPC) is one approach to reducing the likelihood of a VTE. Adherence to IPC is known to be inadequate though the reasons for this remain unclear. This systematic review explores factors that affect adherence to IPC in the inpatient context.

Methods

Information sources—EMBASE, MEDLINE and PsycINFO were searched for literature between January 1960 and May 2019. Eligibility criteria—studies were included if they focused on inpatient care and examined factors affecting adherence to IPC devices.

Results

Included studies—a total of 20 out of 1476 studies were included. Synthesis of results—eight factors were identified that affected adherence: patient discomfort (n=8), healthcare professionals’ knowledge and behaviours (n=6), mobilisation (n=6), equipment supply and demand (n=3), the use of guidelines (n=3), intensive care context (n=2), computer-assisted prescribing (n=2) and patients’ knowledge of IPC (n=1).

Conclusion

Overall while the evidence base is quite limited, a number of factors were shown to affect adherence to IPC. These findings could be used to inform future research and quality improvement efforts to increase adherence in this very important, but currently under-researched area.

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Most cited references 39

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Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.

M D Silverstein, J A Heit, D Mohr … (1998)

The incidence of venous thromboembolism has not been well described, and there are no studies of long-term trends in the incidence of venous thromboembolism. To estimate the incidence of deep vein thrombosis and pulmonary embolism and to describe trends in incidence. We performed a retrospective review of the complete medical records from a population-based inception cohort of 2218 patients who resided within Olmsted County, Minnesota, and had an incident deep vein thrombosis or pulmonary embolism during the 25-year period from 1966 through 1990. The overall average age- and sex-adjusted annual incidence of venous thromboembolism was 117 per 100000 (deep vein thrombosis, 48 per 100000; pulmonary embolism, 69 per 100000), with higher age-adjusted rates among males than females (130 vs 110 per 100000, respectively). The incidence of venous thromboembolism rose markedly with increasing age for both sexes, with pulmonary embolism accounting for most of the increase. The incidence of pulmonary embolism was approximately 45% lower during the last 15 years of the study for both sexes and all age strata, while the incidence of deep vein thrombosis remained constant for males across all age strata, decreased for females younger than 55 years, and increased for women older than 60 years. Venous thromboembolism is a major national health problem, especially among the elderly. While the incidence of pulmonary embolism has decreased over time, the incidence of deep vein thrombosis remains unchanged for men and is increasing for older women. These findings emphasize the need for more accurate identification of patients at risk for venous thromboembolism, as well as a safe and effective prophylaxis.

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Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study.

W O'Fallon, L. Joseph Melton, Christine M. Lohse … (2002)

To assess the potential impact of controlling risk factors on the incidence of venous thromboembolism by estimating the population attributable risk (defined as the percentage of all cases of a disease in a population that can be "attributed" to a risk factor) for deep vein thrombosis and pulmonary embolism associated with venous thromboembolism risk factors. Using data from a population-based, nested, case-control study of the 625 Olmsted County, Minnesota, residents with a definite first lifetime deep vein thrombosis or pulmonary embolism diagnosed during the 15-year period 1976 to 1990 and 625 unaffected Olmsted County residents matched for age and sex, we developed a conditional logistic regression model appropriate to the matched case-control study design and then estimated attributable risk for the risk factors individually and collectively. Fifty-nine percent of the cases of venous thromboembolism in the community could be attributed to institutionalization (current or recent hospitalization or nursing home residence). Hospitalization for surgery (24%) and for medical illness (22%) accounted for a similar proportion of the cases, while nursing home residence accounted for 13%. The individual attributable risk estimates for malignant neoplasm, trauma, congestive heart failure, central venous catheter or pacemaker placement, neurological disease with extremity paresis, and superficial vein thrombosis were 18%, 12%, 10%, 9%, 7%, and 5%, respectively. Together, the 8 risk factors accounted for 74% of disease occurrence. Factors associated with institutionalization independently account for more than 50% of all cases of venous thromboembolism in the community. Greater emphasis should be placed on prophylaxis for hospitalized medical patients. Other recognized risk factors account for about 25% of all cases of venous thromboembolism, while the remaining 25% of cases are idiopathic.

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The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs.

Scott D Grosse, Richard E. Nelson, Kwame A Nyarko … (2016)

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is an important cause of preventable mortality and morbidity. In this study, we summarize estimates of per-patient and aggregate medical costs or expenditures attributable to incident VTE in the United States. Per-patient estimates of incremental costs can be calculated as the difference in costs between patients with and without an event after controlling for differences in underlying health status. We identified estimates of the incremental per-patient costs of acute VTEs and VTE-related complications, including recurrent VTE, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension, and anticoagulation-related adverse drug events. Based on the studies identified, treatment of an acute VTE on average appears to be associated with incremental direct medical costs of $12,000 to $15,000 (2014 US dollars) among first-year survivors, controlling for risk factors. Subsequent complications are conservatively estimated to increase cumulative costs to $18,000-23,000 per incident case. Annual incident VTE events conservatively cost the US healthcare system $7-10 billion each year for 375,000 to 425,000 newly diagnosed, medically treated incident VTE cases. Future studies should track long-term costs for cohorts of people with incident VTE, control for comorbid conditions that have been shown to be associated with VTE, and estimate incremental medical costs for people with VTE who do not survive. The costs associated with treating VTE can be used to assess the potential economic benefit and cost-savings from prevention efforts, although costs will vary among different patient groups.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2020

Publication date (Electronic): 3 September 2020

Volume: 10

Issue: 9

Electronic Location Identifier: e037036

Affiliations

[1 ]departmentExecutive Offices, Princess Royal University Hospital , King’s College Hospital NHS Foundation Trust , Farnborough, UK

[2 ]departmentCentre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience , King’s College London , London, UK

Author notes

[Correspondence to ] Richard Greenall; writetorichg@ 123456gmail.com

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Richard Greenall http://orcid.org/0000-0002-8880-7495

Article

Publisher ID: bmjopen-2020-037036

DOI: 10.1136/bmjopen-2020-037036

PMC ID: 7473613

PubMed ID: 32883726

SO-VID: a042d4f9-1060-426b-9b99-9d4f0da0c01f

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 20 January 2020

Date revision received : 15 June 2020

Date accepted : 23 July 2020

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ScienceOpen disciplines: Medicine

Keywords: thromboembolism,bleeding disorders & coagulopathies,quality in health care

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ScienceOpen disciplines: Medicine

Keywords: thromboembolism, bleeding disorders & coagulopathies, quality in health care

Intermittent pneumatic compression for venous thromboembolism prevention: a systematic review on factors affecting adherence

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Most cited references 39

Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.

Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study.

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs.

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