Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA

2018 ◽  
Vol 14 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Kumar Mukherjee ◽  
Khalid M Kamal
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Significant Risk ◽  
Primary Diagnosis ◽  
Inpatient Cost ◽  
Targeted Interventions ◽  
Hospital Discharge Records ◽  
Hospital Characteristics

Background Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708–$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.

scholarly journals Edoxaban versus warfarin on stroke risk in patients with atrial fibrillation: a territory-wide cohort study

2021 ◽  
Author(s):  
Dicken Kong ◽  
Jiandong Zhou ◽  
Sharen Lee ◽  
Keith Sai Kit Leung ◽  
Tong Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Propensity Score ◽  
Ischaemic Stroke ◽  
Propensity Score Matching ◽  
Lower Risk ◽  
Cox Regression ◽  
Significant Risk ◽  
Risk Predictors

AbstractBackgroundIn this territory-wide, observational, propensity score-matched cohort study, we evaluate the development of transient ischaemic attack and ischaemic stroke (TIA/Ischaemic stroke) in patients with AF treated with edoxaban or warfarin.MethodsThis was an observational, territory-wide cohort study of patients between January 1st, 2016 and December 31st, 2019, in Hong Kong. The inclusion were patients with i) atrial fibrillation, and ii) edoxaban or warfarin prescription. 1:2 propensity score matching was performed between edoxaban and warfarin users. Univariate Cox regression identifies significant risk predictors of the primary, secondary and safety outcomes. Hazard ratios (HRs) with corresponding 95% confidence interval [CI] and p values were reported.ResultsThis cohort included 3464 patients (54.18% males, median baseline age: 72 years old, IQR: 63-80, max: 100 years old), 664 (19.17%) with edoxaban use and 2800 (80.83%) with warfarin use. After a median follow-up of 606 days (IQR: 306-1044, max: 1520 days), 91(incidence rate: 2.62%) developed TIA/ischaemic stroke: 1.51% (10/664) in the edoxaban group and 2.89% (81/2800) in the warfarin group. Edoxaban was associated with a lower risk of TIA or ischemic stroke when compared to warfarin.ConclusionsEdoxaban use was associated with a lower risk of TIA or ischemic stroke after propensity score matching for demographics, comorbidities and medication use.

Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy According to Presence or Absence of Atrial Fibrillation

Stroke ◽  
2021 ◽  
Author(s):  
Laurent Fauchier ◽  
Arnaud Bisson ◽  
Alexandre Bodin ◽  
Julien Herbert ◽  
Pascal Spiesser ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Hypertrophic Cardiomyopathy ◽  
Significant Risk ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Clinical Usefulness ◽  
Risk Scores ◽  
Good Prediction ◽  
Good Calibration

Background and Purpose: Patients with hypertrophic cardiomyopathy (HCM) have high risk of ischemic stroke (IS), especially if atrial fibrillation (AF) is present. Improvements in risk stratification are needed to help identify those patients with HCM at higher risk of stroke, whether AF is present or not. Methods: This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adults hospitalized with isolated HCM. A logistic regression model was used to construct a French HCM score, which was compared with the HCM Risk-CVA and CHA 2 DS 2 -VASc scores using c-indexes and calibration analysis. Results: In 32 206 patients with isolated HCM, 12 498 (38.8%) had AF, and 2489 (7.7%) sustained an IS during follow-up. AF in patients with HCM was independently associated with a higher risk for death (hazard ratio, 1.129 [95% CI, 1.088–1.172]), cardiovascular death (hazard ratio, 1.254 [95% CI, 1.177–1.337]), IS (hazard ratio, 1.210 [95% CI, 1.111–1.317]), and other major cardiovascular events. Independent predictors of IS in HCM were older age, heart failure, AF, prior IS, smoking and poor nutrition (all P <0.05). For the HCM Risk-CVA score, CHA 2 DS 2 -VASc score and a French HCM score, all c-indexes were 0.65 to 0.70, with good calibration. Among patients with AF, the CHA 2 DS 2 -VASc score had marginal improvement over the HCM Risk-CVA score but was less predictive compared with the French HCM score ( P =0.001). In patients without AF, both HCM Risk-CVA score and the French HCM score had significantly better prediction compared with CHA 2 DS 2 -VASc (both P <0.0001). Decision curve analysis demonstrated that the French HCM score had the best clinical usefulness of the 3 tested risk scores. Conclusions: Patients with HCM have a high prevalence of AF and a significant risk of IS, and the presence of AF in patients with HCM was independently associated with worse outcomes. A simple French HCM score shows good prediction of IS in patients with HCM and clinical usefulness, with good calibration.

Abstract W MP75: Increase Usage of Acute Stroke Thrombolysis Leads to Better Outcome: The Emergency Medical Service-Discharge Diagnosis Data Linkage Analysis over Three Years

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Amanda Cotter ◽  
Khosrow Heidari ◽  
Michelle Androulakis ◽  
Andrea Griffin ◽  
Karen Cartrett ◽  
...  
Keyword(s):  
South Carolina ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Real Time ◽  
Hospital Discharge ◽  
Data Linkage ◽  
Discharge Diagnosis ◽  
Number Of Patients ◽  
Hospital Discharge Records ◽  
Stroke Thrombolysis

Background and Objective: South Carolina is located in the “buckle” of the stoke belt. Use of the emergency medical services (EMS), intravenous tissue plasminogen activator (IV t-PA) in acute stroke and its correlates, including outcomes have not been trended over time. To study the annual trends in the above acute stroke care parameters we linked the EMS database with the statewide hospital discharge records stored at South Carolina Department of Health and Environmental Control (SC DHEC). Methods: The ongoing statewide EMS database linkage with the hospital discharge records stored at SC DHEC, allow us to track EMS and acute stroke thrombolysis in real-time. Patients with a discharge diagnosis of ischemic stroke were included in the analysis. Patients transported via EMS were compared with patients not transported by EMS. Variables considered included patient demographics, stroke center status of the hospital, telemedicine usage and treatment with IV t-PA for the calendar years of 2010-2012. Results: In the calendar years of 2010-2012, 10,377; 10,532 and 10,900 hospitalized patients in SC were assigned a primary discharge diagnosis of ischemic stroke respectively. Of these, the number of patients transported by EMS that received IV t-PA (7.1%, 9.5% and 10.2%, in the years 2010-12; χ2 trend =15.3, p < 0.0001) shows a significant increasing linear trend over the number of patients that were not transported by EMS that received IV t-PA (2.5%, 3.6% and 3.7%, in the years 2010-12). Over the three years, patients that are treated with IV t-PA were more likely to be discharged home (39%, 42% and 49% in the years 2010-12 ) and less likely to be discharged to a healthcare institution or expire (61%, 58% and 51% in the years 2010-12; χ2 trend=9.3, p =0.002). Conclusion: Transportation by EMS increased the likelihood of receiving IV t-PA. Over three years, IV t-PA usage led to better outcome including increasing discharge to home, decreasing discharge to healthcare institution and death. The real-time data linkage methodology may allow us in future to test the impact of statewide interventions geared to promote the usage of EMS and IV t-PA.

Recurrent vascular events in patients with ischemic stroke/TIA and atrial fibrillation in relation to secondary prevention at hospital discharge

2004 ◽  
Vol 116 (24) ◽  
pp. 834-838 ◽  
Author(s):  
Susanne Tentschert ◽  
Silvia Parigger ◽  
Veronika Dorda ◽  
Kathrin Bittner ◽  
Daniel Unterbuchschachner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Hospital Discharge ◽  
Vascular Events

scholarly journals TOAST Subtypes of Ischemic Stroke and Its Risk Factors: A Hospital-Based Study at Cipto Mangunkusumo Hospital, Indonesia

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Salim Harris ◽  
Saleha Sungkar ◽  
Al Rasyid ◽  
Mohammad Kurniawan ◽  
Taufik Mesiano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Significant Risk ◽  
Large Artery ◽  
Stroke Risk Factor ◽  
Stroke Subtypes ◽  
Undetermined Etiology ◽  
Toast Classification

Background and Purpose. Stroke is a leading cause of death and disability, with ischemic stroke as the highest prevalent cases in Indonesia. Ischemic stroke can be classified further into five subtypes according to TOAST classification. Numerous studies have revealed that stroke risk factor has variable correlation with different stroke subtype. Currently, there is no data regarding this phenomenon in Indonesia. The aim of study is to identify characteristic of ischemic stroke subtypes and the risk factors in TOAST classification. Methods. A retrospective, cross-sectional study of patients diagnosed with ischemic stroke at Cipto Mangunkusumo Hospital from January till December 2016. Demographic data, ischemic stroke subtypes, risk factors, and other relevant data were documented. Bivariate and multivariate analysis was done using SPSS 23. Results. 235 recorded data patients were included. Large artery atherosclerosis (LAA) was the most prevalent stroke subtypes at 59,6%, followed with small vessel disease (SVD) at 26,7%, undetermined etiology at 9,8%, cardioembolism (CE) at 2,1%, and other determined etiology at 0,9%. Hypertension was the most common vascular risk factor. However, it was only significant in SVD (p=0,023) and undetermined etiology subtypes (p<0,001). Significant risk factor in LAA was diabetes (55%; p=0,016) while in CE subtypes was atrial fibrillation (60%;p<0,001). In multivariate analyses, hypertension (OR 3; 95% CI 1,12-8,05) was the only variable that was related to SVD while in CE it was atrial fibrillation (OR 113,5; 95% CI 13,6-946,5). Conclusion. LAA was the most common stroke ischemic subtypes. Associated risk factor in LAA was diabetes while in SVD and undetermined etiology subtypes it was hypertension. Atrial fibrillation was associated with cardioembolism.

Outcomes associated with endovascular treatment among patients with acute ischemic stroke in the USA

2019 ◽  
Vol 12 (4) ◽  
pp. 422-426
Author(s):  
Ansaar T Rai ◽  
Concetta Crivera ◽  
Emilie Kottenmeier ◽  
Iftekhar Kalsekar ◽  
Rashmi Kumari ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Primary Diagnosis ◽  
Economic Outcomes ◽  
Trend Test ◽  
Administrative Claims ◽  
Total Cost ◽  
Economic Trends ◽  
The Usa

BackgroundFew studies have examined the trends in clinical and economic outcomes of patients with acute ischemic stroke (AIS) who receive endovascular therapy (ET) in the real-world setting.ObjectiveTo evaluate characteristics and trends in clinical and economic outcomes among commercially insured patients with AIS undergoing ET between 2011 and 2017.MethodsPatients with AIS undergoing ET from January 1, 2011 to June 30, 2017 were identified from administrative claims contained in the IBM MarketScan Commercial and Medicare Supplemental databases. The Mann–Kendall trend test was performed to examine clinical and economic trends.Between 2011 and 2017, 3411 patients (mean age 62.85±15 years) with a primary diagnosis of AIS underwent ET (coverage: Commercial 59%, n=2008; Medicare Supplemental 41%, n=1403). In the Commercial cohort, discharge to home increased significantly (from 29.54% to 39.18%, p<0.05). Length of stay declined significantly among the overall cohort (from 10.96 to 9.05 days, p<0.01) and the Medicare Supplemental cohort (from 10.03 to 8.43 days, p<0.05). All-cause 365-day readmission decreased significantly among the overall cohort (from 47.5% to 36.7%, p<0.05) and the Commercial cohort (from 51.54% to 36.43%, p<0.05) but remained unchanged in the Medicare Supplemental cohort. While index procedure cost did not change significantly ($93 955 to $87 906, p=0.8806), total cost significantly declined in the overall cohort (from $166 922 to $130 678, p<0.05).ConclusionsAlthough with some variation across the samples studied, outcomes including discharge to home, length of stay, readmission, and total cost associated with endovascular stroke therapy seemed to have improved between 2011 and 2017. Index admission cost remained unchanged.

Abstract 126: Derivation and Validation of a Proposed Long Length of Stay (≥ 7 days) Score in Patients Hospitalized for Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Nabeel Chauhan ◽  
Nicolas Bianchi ◽  
Aneesh B Singhal ◽  
Lee H Schwamm
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Carotid Stenosis ◽  
External Validation ◽  
Predictive Score ◽  
Internal Validation ◽  
Altered Level ◽  
Derivation Cohort ◽  
Previous Stroke

Introduction: Long length of stay (LLOS) is one of the main factors in the determination of high cost in hospitalized stroke patients. Our aim was to prospectively predict patients more likely to have a long length of stay using our hospitals Get with the guidelines (GWTG) ischemic stroke registry. Methods: We selected 5,400 patients from our database of which 3,400 (~70%) were used for the derivation cohort and 2,000 (~30%) were used for internal validation. For external validation, 730 patients were included from the University of Arkansas. Long length of stay was defined ≥ 7 days. A predictive score was developed using stepwise logistic regression, and its performance assessed using ROC curve analysis. Result: Patients with LLOS in the derivation cohort were more likely to female, self-pay, more often have diabetes mellitus, atrial fibrillation, heart failure, previous stroke and carotid stenosis, and more often presented with weakness. They were more likely to have received IV or IA thrombolysis and early antithrombotics, and had higher rates of pneumonia (18.8% vs. 2.6%) and UTI (16.7% vs. 5.3%). Independent predictors of LLOS were Medicare/Medicaid insurance, self pay, history of atrial fibrillation, CAD, previous stroke, carotid stenosis, higher NIHSS and altered level of consciousness at presentation. The LLOS score (Table 2) performed well on ROC analysis (Derivation cohort AUC=0.72, Internal validation AUC=0.73 and External validation AUC=0.77). Conclusion: Many factors play a role in determining the length of stay for AIS patients. Our study provides a scoring system that may help physicians predict which patients are more likely to have a prolonged hospital stay.

scholarly journals Individual and Combined Impact of Heart Failure and Atrial Fibrillation on Ischemic Stroke Outcomes

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1838-1845 ◽  
Author(s):  
Tiberiu A. Pana ◽  
David J. McLernon ◽  
Mamas A. Mamas ◽  
Joao H. Bettencourt-Silva ◽  
Anthony K. Metcalf ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Stroke Recurrence ◽  
Stroke Outcomes ◽  
Long Term Mortality

Background and Purpose— We aimed to determine individual and combined effects of atrial fibrillation (AF) and heart failure (HF) on acute ischemic stroke outcomes: in-hospital mortality, length-of-stay, and poststroke disability; long-term mortality and stroke recurrence. Methods— Prospective cohort study of patients with acute ischemic stroke admitted to a UK center with a catchment population of ≈900 000 between 2004 and 2016. Exposure groups were patients with neither AF nor HF (reference group), those with AF but without HF, those with HF but without AF, and those with AF+HF. Logistic and Cox regressions were used to model in-hospital and long-term outcomes, respectively. Results— A total of 10 816 patients with a mean age±SD =77.9±12.1 years, 48% male were included. Only 30 (4.9%) of the patients with HF but not AF were anticoagulated at discharge. Both AF (odds ratio, 1.24 [95% CI, 1.07–1.43]), HF (odds ratio, 1.40 [1.10–1.79]), and their combination (odds ratio, 2.23 [1.83–2.72]) were associated with increased odds of in-hospital mortality. All 3 exposure groups were associated with increased length-of-stay, while only AF predicted increased disability (1.36 [1.12–1.64]). Patients were followed for a median of 5.5 and 3.7 years for mortality and recurrence, respectively. Long-term mortality was associated with AF (hazard ratio, 1.45 [95% CI, 1.33–1.59]), HF (2.07 [1.83–2.36]), and their combination (2.20 [1.96–2.46]). Recurrent stroke was associated with AF 1.50 (1.26–1.78), HF (1.33 [1.01–1.75]), and AF with HF (1.62 [1.28–2.07]). Conclusions— The AF-associated excess risk of stroke recurrence was independent of comorbid HF. HF without AF was also associated with a significant risk of recurrence. Anticoagulation for secondary stroke prevention in patients with HF without AF may require further evaluation in a clinical trial setting.

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