Hospital Costs Associated With Atrial Fibrillation for Patients With Ischemic Stroke Aged 18–64 Years in the United States

Background and Purpose— Hospital costs associated with atrial fibrillation (AFib) among patients with stroke have not been well-studied, especially among people aged <65 years. We estimated the AFib-associated hospital costs in US patients aged 18 to 64 years. Methods— We identified hospital admissions with a primary diagnosis of ischemic stroke from the 2010 to 2012 MarketScan Commercial Claims and Encounters inpatient data sets, excluding those with capitated health insurance plans, aged <18 or >64 years, missing geographic region, hospital costs below the 1st or above 99th percentile, and having carotid intervention (n=40 082). We searched the data for AFib and analyzed the costs for nonrepeat and repeat stroke admissions separately. We estimated the AFib-associated costs using multivariate regression models controlling for age, sex, geographic region, and Charlson comorbidity index. Results— Of the 33 500 nonrepeat stroke admissions, 2407 (7.2%) had AFib. Admissions with AFib cost $4991 more than those without AFib ($23 770 versus $18 779). For the 6582 repeat stroke admissions, 397 (6.0%) had AFib. The costs were $3260 more for those with AFib than those without ($24 119 versus $20 929). After controlling for potential confounders, AFib-associated costs for nonrepeat stroke admissions were $4905, representing 20.6% of the total costs for the admissions. Both the hospital costs and the AFib-associated costs were associated with age, but not with sex. AFib-associated costs for repeat stroke admissions were not significantly higher than for non-AFib patients, except for those aged 55 to 64 years ($3537). Conclusions— AFib increased the hospital cost of ischemic stroke substantially. Further investigation on AFib-associated costs for repeat stroke admissions is needed.

[1]  E. Arias,et al.  Mortality in the United States, 2013. , 2014, NCHS data brief.

[2]  David J Gladstone,et al.  Atrial fibrillation in patients with cryptogenic stroke. , 2014, The New England journal of medicine.

[3]  Mary G. George,et al.  Costs of hospitalization for stroke patients aged 18-64 years in the United States. , 2014, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[4]  K. D. de Laat,et al.  Observational Dutch Young Symptomatic StrokE studY (ODYSSEY): study rationale and protocol of a multicentre prospective cohort study , 2014, BMC Neurology.

[5]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2014 update: a report from the American Heart Association. , 2014, Circulation.

[6]  R. Yufe Stroke prognostication using age and NIH Stroke Scale: SPAN-100 , 2013, Neurology.

[7]  H. Wijeysundera,et al.  Economic Evaluation of Percutaneous Left Atrial Appendage Occlusion, Dabigatran, and Warfarin for Stroke Prevention in Patients With Nonvalvular Atrial Fibrillation , 2013, Circulation.

[8]  N. Limdi,et al.  USING INTERNATIONAL CLASSIFICATION OF DISEASES NINTH REVISION CODES OVERESTIMATES THE FREQUENCY OF TRUE STROKE , 2013 .

[9]  D. Cutler,et al.  Measuring health care costs of individuals with employer-sponsored health insurance in the U.S.: A comparison of survey and claims data. , 2013, Statistical journal of the IAOS.

[10]  M. J. Hall,et al.  Hospitalization for stroke in U.S. hospitals, 1989-2009. , 2012, NCHS data brief.

[11]  H. Kamel,et al.  Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Patients With Atrial Fibrillation and Prior Stroke or Transient Ischemic Attack , 2012, Stroke.

[12]  K. Butcher,et al.  Risks and Benefits of Thrombolysis in the Elderly , 2012, International journal of stroke : official journal of the International Stroke Society.

[13]  H. Cloft,et al.  Hospitalization Costs for Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis in the United States Are Substantially Higher Than Medicare Payments , 2012, Stroke.

[14]  Mary G. George,et al.  Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995–2008 , 2011, Annals of neurology.

[15]  S. Johnston,et al.  Estimation of Total Incremental Health Care Costs in Patients With Atrial Fibrillation in the United States , 2011, Circulation. Cardiovascular quality and outcomes.

[16]  S. Connolly,et al.  Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: A Canadian payer perspective , 2011, Thrombosis and Haemostasis.

[17]  A. Khera,et al.  Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement From the American Heart Association , 2011, Circulation.

[18]  R. P. Zhu,et al.  Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Atrial Fibrillation , 2011, Annals of Internal Medicine.

[19]  B. Gage,et al.  Cost-Effectiveness of Dabigatran for Stroke Prophylaxis in Atrial Fibrillation , 2010, Circulation.

[20]  Hilary K. Wall,et al.  Costs of heart failure-related hospitalizations in patients aged 18 to 64 years. , 2010, The American journal of managed care.

[21]  Partha Deb,et al.  Medicare Spending and Outcomes After Postacute Care for Stroke and Hip Fracture , 2010, Medical care.

[22]  B. Demaerschalk,et al.  US cost burden of ischemic stroke: a systematic literature review. , 2010, The American journal of managed care.

[23]  Guijing Wang,et al.  Hospitalization costs associated with hypertension as a secondary diagnosis among insured patients aged 18-64 years. , 2010, American journal of hypertension.

[24]  G. Nichols,et al.  Medical care costs among patients with established cardiovascular disease. , 2009, The American journal of managed care.

[25]  J. Schomburg Prevention of stroke in patients with atrial fibrillation. , 2012, The Medical letter on drugs and therapeutics.

[26]  D. Singer,et al.  Cost-effectiveness of warfarin: trial versus "real-world" stroke prevention in atrial fibrillation. , 2009, American heart journal.

[27]  Jennifer M. Hootman,et al.  Prevalence and most common causes of disability among adults--United States, 2005. , 2009, MMWR. Morbidity and mortality weekly report.

[28]  A. Di Carlo Human and economic burden of stroke. , 2009, Age and ageing.

[29]  J. King,et al.  MATERNAL MORTALITY IN THE UNITED STATES , 1951, American journal of public health.

[30]  Peter Lindgren,et al.  Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. , 2008, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[31]  G. Lamas,et al.  Direct treatment cost of atrial fibrillation in the elderly American population: a Medicare perspective , 2008, Journal of medical economics.

[32]  J. Menzin,et al.  One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database. , 2008, Current medical research and opinion.

[33]  David M. Adamson,et al.  HealtH ReseaRcH Data foR tHe Real WoRlD: tHe MaRketscan ® Databases , 2008 .

[34]  Jennifer W. Kahende,et al.  Assessing medical expenditures on 4 smoking-related diseases, 1996-2001. , 2007, American journal of health behavior.

[35]  A. Divani,et al.  Changes in Cost and Outcome Among US Patients With Stroke Hospitalized in 1990 to 1991 and Those Hospitalized in 2000 to 2001 , 2007, Stroke.

[36]  C. Pashos,et al.  Long-Term Cost of Stroke Subtypes among Medicare Beneficiaries , 2006, Cerebrovascular Diseases.

[37]  R. Sacco,et al.  Projected costs of ischemic stroke in the United States , 2006, Neurology.

[38]  L. Wier,et al.  The National Hospital Bill: The Most Expensive Conditions by Payer, 2008 , 2011 .

[39]  S. Sacco,et al.  Contribution of Atrial Fibrillation to Incidence and Outcome of Ischemic Stroke: Results From a Population-Based Study , 2005, Stroke.

[40]  R. Rinaldi,et al.  Accuracy of ICD-9 codes in identifying ischemic stroke in the General Hospital of Lugo di Romagna (Italy) , 2003, Neurological Sciences.

[41]  D. Mandell,et al.  Economic grand rounds: medical expenditures among children with psychiatric disorders in a Medicaid population. , 2003, Psychiatric services.

[42]  Paul J Rathouz,et al.  Comorbidity and the Concentration of Healthcare Expenditures in Older Patients with Heart Failure , 2003, Journal of the American Geriatrics Society.

[43]  P. Duncan,et al.  Inaccuracy of the International Classification of Diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease , 1997, Neurology.

[44]  R B D'Agostino,et al.  Stroke severity in atrial fibrillation. The Framingham Study. , 1996, Stroke.

[45]  B. Norrving,et al.  Cost effectiveness of primary stroke prevention in atrial fibrillation: Swedish national perspective. , 1992, BMJ.

[46]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[47]  Silvia G. Priori,et al.  ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the European society of cardiology committee for PRAC , 2006 .