PCV40 - Costs Of Ischemic Stroke With And Without Atrial Fibrillation In Colombia

Abstract

To estimate total costs and resource use of acute hospital care in a sample of patients with large vessel ischemic stroke treated at our University Hospital, comparing those with and without non-valvular atrial fibrillation (AF). We collected a sequential, prospective, convenience sample of patients 50 years of age or older, admitted between December 2010 and March 2013 diagnosed with ischemic stroke, excluding lacunar infarct, transitory cerebral ischemia, recurrent stroke or modified Rankin index greater than 2 prior to this episode. The presence of AF was sought with electrocardiogram and in some cases was studied with Holter. For a separate analysis, we matched for age and admission NIHSS score, in a 1:1 ratio, patients with and without AF. Variables measured in all cases were: age, gender, admission and discharge NIHSS, modified Rankin index, and CHA2DS2VASC score. Prospectively, we collected in-hospital resource use and costs incurred during the acute event. Exchange rate 1805 Colombian pesos = 1 American dollar (USD). 166 patients were analyzed, 125 without and 41 with non-valvular AF. For the paired analysis, we considered 37 patients with and 37 without AF. The average total cost of acute care for all stroke patients was USD$4,163 (SD $7,163) This value was USD$5,729 (SD $8,383) for patients with AF and for patients without AF USD$4,464 (SD $6,712). 15 patients (9%) died during the hospitalization, 9 with AF (22%) and 6 without AF (5%). Of the matched group, 9 of the 37 patients with (24%) and 4 of those without (10%) required intensive care. 25% of large vessel ischemic stroke patients had AF. Treatment costs are higher in patients with AF, since they are older and with more severe strokes. Cost difference is reduced and shows no statistical significance when adjusted for age and stroke severity.