title: Cost of acute stroke care for patients with atrial fibrillation compared with those in sinus rhythm.
abstract: 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 £6,978 (standard deviation [SD] 6,769, range 510-36,952). Mean (SD) costs were significantly higher for patients with AF than for those without (£9,083 [7,381] vs. £5,729 [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 £2,173 (95% confidence interval 91-4,254; p = 0.041). Costs for patients with an ICH did not differ according to cardiac rhythm.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Stroke Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK, ali-ali@doctors.org.uk.
authors.forename: Ali N
authors.initials: AN
authors.lastname: Ali
authors.forename: Joanne
authors.initials: J
authors.lastname: Howe
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel-Hafiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D001146:Arrhythmia, Sinus / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000191:economics* / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants