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

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 A 6,978 pound (standard deviation [SD] 6,769, range 510-36,952). Mean (SD) costs were significantly higher for patients with AF than for those without (A 9,083 pound [7,381] vs. A 5,729 pound [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 A 2,173 pound (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.