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Cost of Acute Stroke Care for Patients with Atrial Fibrillation Compared with Those in Sinus Rhythm

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Abstract

Background

Atrial fibrillation (AF) is a major risk factor for stroke. Cost-effectiveness studies of anticoagulants for stroke prevention in AF rarely utilise AF-stroke-specific cost data in their analyses, as data are limited. Data that exist do not account for AF found on prolonged cardiac monitoring after stroke, further underestimating the clinical and economic burden of AF-stroke.

Objective

Our objective was to investigate differences in direct medical costs of acute stroke care among patients with and without AF.

Methods

Data were prospectively collected from 213 consecutive patients with confirmed stroke (196 ischaemic [IS], 17 intracranial haemorrhage [ICH]), admitted to a UK district general hospital between November 2011 and October 2012. Sociodemographic, clinical and cardiac monitoring characteristics were recorded, and resource use was calculated using a ‘bottom-up’ approach. Univariate and multivariate stepwise regressions were performed to identify predictors of direct cost.

Results

Among patients with IS, 73 had AF (37 %). These patients were older, experienced greater stroke severity, lengths of hospitalisation, inpatient mortality and discharge to institutionalised care than those without AF. Mean acute care costs for the year 2012 were £6,978 (standard deviation [SD] 6,769, range 510–36,952). Mean (SD) costs were significantly higher for patients with AF than for those without (£9,083 [7,381] vs. £5,729 [6,071], p = <0.001). AF independently predicted acute care cost along with history of heart failure and stroke severity. The adjusted independent effect of having AF on costs was an additional £2,173 (95 % confidence interval 91–4,254; p = 0.041). Costs for patients with an ICH did not differ according to cardiac rhythm.

Conclusion

Direct medical costs of acute stroke care for patients with AF may be 50 % greater than for patients without. Economic studies should take this into account to ensure the benefits of anticoagulants are not underestimated.

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Acknowledgments

Neither the data nor the models or methodology within the study are proprietary. No financial support for this study was sought. Publication of the study is not contingent on any sponsor approval.

The authors acknowledge Jeanette Harris for help with data collection and Caroline Leggot from the finance department at Rotherham General Hospital. This study was completed without any funding support. No conflicts of interest existed for any of the named authors of this study.

Author contributions

Ms Joanne Howe undertook data collection and manuscript editing. Dr Ali Ali undertook study design, assisted in data collection, performed data analysis and manuscript writing and submission. Dr Abdel-Hafiz assisted in study design, data analysis and manuscript editing and acts as guarantor for the study.

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Correspondence to Ali N. Ali.

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Ali, A.N., Howe, J. & Abdel-Hafiz, A. Cost of Acute Stroke Care for Patients with Atrial Fibrillation Compared with Those in Sinus Rhythm. PharmacoEconomics 33, 511–520 (2015). https://doi.org/10.1007/s40273-015-0263-1

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