Trends and Predictors of Vena Cava Filter Use (2004-2023): A Swiss Nationwide Epidemiological Study

Background: Recent data on inferior vena cava filter (IVCF) placement mainly originate from the United States, with limited evidence from Europe. Methods: We used nationwide, patient-level data from 2004 to 2023, including hospitalizations with mention of IVCF placement or venous thromboembolism (VTE). Placement was classified as secondary prevention if VTE was documented during the hospitalization, otherwise as primary prevention. We assessed IVCF placement rates overall and in patients with pulmonary embolism (PE), and studied in-hospital case fatality rates, retrieval rates, and length of hospitalization. Analyses were stratified by prevention type and sex. Results: IVCF placement was recorded in 5,123 (81.1% secondary prevention) patients. The age-standardized rate of IVCF placement increased from 3.4 (95% confidence interval [CI]: 2.0; 4.8) per 1,000 PE-related hospitalizations in 2004 to 19.2 (95% CI: 16.7; 21.6) per 1,000 PE-related hospitalizations in 2023. The IVCF-related in-hospital case fatality rate increased from 7.1% (95% CI: 1.1; 13.2) in 2004 to 10.2% (95% CI: 7.2; 13.3) in 2023 and was higher after IVCF placement for secondary prevention than for primary prevention. The estimated retrieval rate within an average of 6 months was 31.9% (95% CI: 29.9; 34.0), peaking at 34.6% (95% CI: 32.4; 36.8) after excluding deaths during index hospitalization. The retrieval rate decreased progressively over time. IVCFs were less likely to be retrieved among older patients and in patients with intracranial hemorrhage or cancer, whereas the removal rate was higher among patients with recent trauma. Conclusion: We showed an increasing trend of IVCF placement procedures. The IVCF retrieval rate decreased over time, emphasizing the need for improved follow-up protocols.