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      Comparison of costs and discharge outcomes for patients hospitalized for ischemic or hemorrhagic stroke with or without atrial fibrillation in the United States

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          Abstract

          This retrospective analysis investigated the impact of baseline clinical characteristics, including atrial fibrillation (AF), on hospital discharge status (to home or continuing care), mortality, length of hospital stay, and treatment costs in patients hospitalized for stroke. The analysis included adult patients hospitalized with a primary diagnosis of ischemic or hemorrhagic stroke between January 2006 and June 2011 from the premier alliance database, a large nationally representative database of inpatient health records. Patients included in the analysis were categorized as with or without AF, based on the presence or absence of a secondary listed diagnosis of AF. Irrespective of stroke type (ischemic or hemorrhagic), AF was associated with an increased risk of mortality during the index hospitalization event, as well as a higher probability of discharge to a continuing care facility, longer duration of stay, and higher treatment costs. In patients hospitalized for a stroke event, AF appears to be an independent risk factor of in-hospital mortality, discharge to continuing care, length of hospital stay, and increased treatment costs.

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          Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.

          A S Go, E Hylek, K. Phillips … (2001)
          Atrial fibrillation is the most common arrhythmia in elderly persons and a potent risk factor for stroke. However, recent prevalence and projected future numbers of persons with atrial fibrillation are not well described. To estimate prevalence of atrial fibrillation and US national projections of the numbers of persons with atrial fibrillation through the year 2050. Cross-sectional study of adults aged 20 years or older who were enrolled in a large health maintenance organization in California and who had atrial fibrillation diagnosed between July 1, 1996, and December 31, 1997. Prevalence of atrial fibrillation in the study population of 1.89 million; projected number of persons in the United States with atrial fibrillation between 1995-2050. A total of 17 974 adults with diagnosed atrial fibrillation were identified during the study period; 45% were aged 75 years or older. The prevalence of atrial fibrillation was 0.95% (95% confidence interval, 0.94%-0.96%). Atrial fibrillation was more common in men than in women (1.1% vs 0.8%; P<.001). Prevalence increased from 0.1% among adults younger than 55 years to 9.0% in persons aged 80 years or older. Among persons aged 50 years or older, prevalence of atrial fibrillation was higher in whites than in blacks (2.2% vs 1.5%; P<.001). We estimate approximately 2.3 million US adults currently have atrial fibrillation. We project that this will increase to more than 5.6 million (lower bound, 5.0; upper bound, 6.3) by the year 2050, with more than 50% of affected individuals aged 80 years or older. Our study confirms that atrial fibrillation is common among older adults and provides a contemporary basis for estimates of prevalence in the United States. The number of patients with atrial fibrillation is likely to increase 2.5-fold during the next 50 years, reflecting the growing proportion of elderly individuals. Coordinated efforts are needed to face the increasing challenge of optimal stroke prevention and rhythm management in patients with atrial fibrillation.
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            Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study.

            Yoko Miyasaka, Marion Barnes, Kent Bailey … (2007)
            The purpose of this study was to assess the mortality trends of atrial fibrillation (AF) in a community. Limited data exist regarding the mortality trends of patients diagnosed with first AF. A community-based cohort of adult residents of Olmsted County, Minnesota, who had electrocardiogram-confirmed first-documented AF in the years 1980 to 2000 were identified and followed to 2004 or death. The primary outcome was all-cause mortality. Of a total of 4,618 residents (mean age 73 +/- 14 years) diagnosed with first AF, 3,085 died during a mean follow-up of 5.3 +/- 5.0 years. Relative to the age- and gender-matched general Minnesota population, the mortality risk was increased (p < 0.0001) with a hazard ratio (HR) of 9.62 (95% confidence interval [CI] 8.93 to 10.32) within the first 4 months and 1.66 (95% CI 1.59 to 1.73) thereafter. Cox proportional hazards modeling showed no change in overall age- and gender-adjusted mortality (HR for the year 2000 vs. 1980: 0.99; 95% CI 0.86 to 1.13; p = 0.84), even after adjustment for comorbidities. In secondary analyses, no changes in mortality were seen for early (within first 4 months) or late (after 4 months) mortality for the entire group or within the subgroup of patients who did not have cardiovascular disease at baseline. In this cohort of patients newly diagnosed with AF, mortality risk was high, especially within the first 4 months. There was no evidence for any significant changes over the 21 years in terms of overall mortality, early or late mortality, or mortality among patients without pre-existing cardiovascular disease.
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              Stroke Associated with Atrial Fibrillation – Incidence and Early Outcomes in the North Dublin Population Stroke Study

              Niamh Hannon, Orla C Sheehan, Lisa Kelly … (2009)
              Background: Prospective population-based studies are important to accurately determine the incidence and characteristics of stroke associated with atrial fibrillation (AF), while avoiding selection bias which may complicate hospital-based studies. Methods: We investigated AF-associated stroke within the North Dublin Population Stroke Study, a prospective cohort study of stroke/transient ischaemic attack in 294,592 individuals, according to recommended criteria for rigorous stroke epidemiological studies. Results: Of 568 stroke patients ascertained in the first year, 31.2% (177/568) were associated with AF (90.4%, i.e. 160/177 ischaemic infarcts). The crude incidence rate of all AF-associated stroke was 60/100,000 person-years (95% CI = 52–70). Prior stroke was almost twice as common in AF compared to non-AF groups (21.9 vs. 12.8%, p = 0.01). The frequency of AF progressively increased across ischaemic stroke patients stratified by increasing stroke severity (NIHSS 0–4, 29.7%; 5–9, 38.1%; 10–14, 43.8%; ≥15, 53.3%, p < 0.0001). The 90-day trajectory of recovery of AF-associated stroke was identical to that of non-AF stroke, but Rankin scores in AF stroke remained higher at 7, 28 and 90 days (p < 0.001 for all). Discussion: AF-associated stroke occurred in one third of all patients and was associated with a distinct profile of recurrent, severe and disabling stroke. Targeted strategies to increase anticoagulation rates may provide a substantial benefit to prevent severe disabling stroke at a population level.
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                Author and article information

                Contributors
                Xianying Pan: (203) 677-7631 , xianying.pan@bms.com
                Journal
                Journal ID (nlm-ta): J Thromb Thrombolysis
                Journal ID (iso-abbrev): J. Thromb. Thrombolysis
                Title: Journal of Thrombosis and Thrombolysis
                Publisher: Springer US (Boston )
                ISSN (Print): 0929-5305
                ISSN (Electronic): 1573-742X
                Publication date (Electronic): 5 November 2014
                Publication date PMC-release: 5 November 2014
                Publication date (Print): 2015
                Volume: 39
                Issue: 4
                Pages: 508-515
                Affiliations
                [ ]Global Health Economics and Outcomes Research, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, CT 06492 USA
                [ ]Global Pharmacovigilence and Epidemiology, Bristol-Myers Squibb Company, Hopewell, NJ 08534 USA
                [ ]Global Health Economics and Outcomes Research, Bristol-Myers Squibb Company, 100 Nassau Park Boulevard, 3.NN37, Princeton, NJ 08543 USA
                [ ]Department of Pricing and Market Access, Celgene Corporation, 33 Technology Drive, Warren, NJ 07059 USA
                Article
                Publisher ID: 1144
                DOI: 10.1007/s11239-014-1144-8
                PMC ID: 4379390
                PubMed ID: 25371108
                SO-VID: 0d226775-ddc3-46d0-b532-ed0aedba046b
                Copyright © © The Author(s) 2014
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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                Subject: Article
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                issue-copyright-statement © Springer Science+Business Media New York 2015

                ScienceOpen disciplines: Hematology
                Keywords: atrial fibrillation,hemorrhagic stroke,ischemic stroke,patient outcomes
                Data availability:
                ScienceOpen disciplines: Hematology
                Keywords: atrial fibrillation, hemorrhagic stroke, ischemic stroke, patient outcomes

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