Venous thromboembolism remains a recognized complication in patients with heart failure, but whether risk varies across ejection fraction phenotypes has been unclear. This retrospective cohort study published in Internal and Emergency Medicine evaluated the incidence of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, among adults with newly diagnosed heart failure and identified independent clinical and laboratory predictors between 2017 and 2024 at a tertiary medical center. Patients receiving chronic anticoagulation or with major prothrombotic disorders were excluded from the analysis. Incident VTE events occurring in inpatient and outpatient settings were identified during longitudinal follow-up.

Among 4,211 patients followed for a median of 6.2 years (IQR 4.6–7.5 years), 256 (6.1%) developed VTE. Crude incidence varied by phenotype, with higher rates observed in preserved ejection fraction (7.4%; 142/1,930) compared with reduced ejection fraction (4.6%; 74/1,618). However, after multivariable adjustment, heart failure phenotype was not independently associated with VTE risk.

Patients who developed VTE were older and had lower serum albumin, lower hemoglobin, impaired kidney function, and higher prevalence of chronic obstructive pulmonary disease. Cardiovascular survival analysis demonstrated no significant difference between patients with and without VTE in unadjusted (log-rank p=0.52) or adjusted models (HR 0.76; 95% CI 0.30–1.93; p=0.57).

VTE occurred in 6.1% of patients with newly diagnosed heart failure over long-term follow-up and was associated with patient-level clinical and laboratory factors rather than heart failure phenotype.