Atrial Fibrillation as an Ischemic Stroke Clinical and Economic Burden Modifier: A 15-Year Nationwide Study

Santos, João Vasco; Pereira, João; Pinto, Roberto; Castro, Pedro; Azevedo, Elsa; Freitas, Alberto

doi:10.1016/j.jval.2017.04.018

Cited by 19 publications

(12 citation statements)

References 72 publications

(138 reference statements)

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“…Health records are not just meant for clinical purposes. The information contained in the records from inpatients and outpatients is systematically abstracted, coded and grouped into diagnosis-related groups, generating an administrative database used for reimbursement and further reused for research (Freitas et al, 2012;Pinho et al, 2015;Santos et al, 2016Santos et al, , 2017Sousa-Pinto et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Health records as the basis of clinical coding: Is the quality adequate? A qualitative study of medical coders’ perceptions

Vera

Santos

Pinto

et al. 2019

HIM J

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Background: Health records are the basis of clinical coding. In Portugal, relevant diagnoses and procedures are abstracted and categorised using an internationally accepted classification system and the resulting codes, together with the administrative data, are then grouped into diagnosis-related groups (DRGs). Hospital reimbursement is partially calculated from the DRGs. Moreover, the administrative database generated with these data is widely used in research and epidemiology, among other purposes. Objective: To explore the perceptions of medical coders (medical doctors) regarding possible problems with health records that may affect the quality of coded data. Method: A qualitative design using four focus groups sessions with 10 medical coders was undertaken between October and November 2017. The convenience sample was obtained from four public hospitals in Portugal. Questions related to problems with the coding process were developed from the literature and authors’ expertise. The focus groups sessions were taped, transcribed and analysed to elicit themes. Results: There are several problems, identified by the focus groups, in health records that influence the coded data: the lack of or unclear documented information; the variability in diagnosis description; “copy & paste”; and the lack of solutions to solve these problems. Conclusion and implications: The use of standards in health records, audits and physician awareness could increase the quality of health records, contributing to improvements in the quality of coded data, and in the fulfilment of its purposes (e.g. more accurate payments and more reliable research).

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Section: Introductionmentioning

confidence: 99%

Health records as the basis of clinical coding: Is the quality adequate? A qualitative study of medical coders’ perceptions

Vera

Santos

Pinto

et al. 2019

HIM J

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“…Although ischemic stroke is considered a complex disease, approximately 20 % of ischemic stroke cases develop due to cardiac embolism caused mainly by atrial fibrillation [5,6]. To the best of our knowledge, this is the first study to evaluate the roles of several neuronal and glial cytoskeletal specific proteins and an angiogenesis suppressor (angiostatin) as markers of citicoline effects in patients with ischemic stroke as a complication of atrial fibrillation.…”

Section: Dynamics Of Clinical and Laboratory Parameters In Patients Wmentioning

confidence: 96%

“…It is well acknowled ged that atrial fibrillation is the most prevalent car-diac arrhythmia, affecting approximately 12% of the population worldwide. Being an independent risk factor for stroke, atrial fibrillation is associated with high mortality, morbidity, and socioeconomic burden [6]. Therefore, stroke prevention with appropriate prophylaxis remains central to management of both atrial fibrillation and its neurological complications.…”

mentioning

confidence: 99%

Citicoline affects serum angiostatin and neurospecific protein levels in patients with atrial fibrillation and ischemic stroke

Tykhomyrov¹,

Kushnir²,

Nedzvetsky³

et al. 2019

Ukr.Biochem.J.

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Ischemic stroke is considered as one of the most frequent and severe complications of atrial fibrillation. The present study was undertaken to examine whether post-insult treatment with cytidine diphosphate-choline (CDP-choline, or citicoline) affects serum levels of the angiogenesis inhibitor angiostatin and neurospecific proteins as markers of brain damage in patients with cerebral ischemia associated with atrial fibrillation. Thirty-three patients with a diagnosis of acute ischemic stroke received citicoline sodium by intravenous infusions (1,000 mg daily for 14 days) in addition to the standard treatment (basic group). Twentyfive patients with the same pathologies, who received only standard therapy, were enrolled in the study as a control group. Serum content of angiostatin and neurospecific proteins, namely neurofilament heavy subunit (NF-H) and glial fibrillary acidic protein (GFAP), was measured by immunoblotting at the basal level and after the treatment. Citicoline treatment caused significant decreases in serum levels of angiostatin (by 40% vs. basal level, P < 0.05), GFAP (by 61%, P < 0.01), and the NF-H subunit (by 19%, P < 0.05) and had no effect on the serum albumin content. In contrast, there were no statistically significant differences between baseline levels of the studied protein markers and their content after the treatment period in the control group. These findings indicate for the first time that CDP-choline protects both astrocytes and neurons and improves angiogenic capacity through down-regulation of angiostatin in post-ischemic patients with atrial fibrillation after acute ischemic stroke. Further studies are needed to test associations between serum levels of these biomarkers, clinical outcomes, and treatment efficacy of stroke. K e y w o r d s: atrial fibrillation, ischemic stroke, citicoline, angiostatin, neurofilaments (NFs), glial fibrillary acidic protein (GFAP).I schemic stroke is a complex multifactorial and polygenic disease. It is generally accepted that one of the major risk factors for ischemic stroke is atrial fibrillation [1]. Past studies indicate that fibrillation of the atrium produces stasis of blood, which causes thrombus formation and embolism in the brain [2,3]. More recent investigations suggest that the pathogenesis of stroke in atrial fibrillation is more complicated and involves other factors in addition to the dysrhythmia [4,5]. It is well acknowled ged that atrial fibrillation is the most prevalent car-diac arrhythmia, affecting approximately 12% of the population worldwide. Being an independent risk factor for stroke, atrial fibrillation is associated with high mortality, morbidity, and socioeconomic burden [6]. Therefore, stroke prevention with appropriate prophylaxis remains central to management of both atrial fibrillation and its neurological complications. However, the search for effective neuroprotectors remains frustrating, and the current therapeutic protocols remain suboptimal. Ideally, sufficient protection must be provided to the ischemic brain a...

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“…Ischaemic stroke is the commonest aetiology seen in AF-related stroke patients, which is often associated with higher costs and a more severe prognosis [9]. AF-related strokes tend to be more severe due to a higher mortality risk and increased disability rate in patients, resulting in longer hospital stays with higher direct costs of stroke care [10]. Based on these factors, it is not surprising that the established economic burden of stroke may be further exacerbated by concomitant presence of AF.…”

Section: Introductionmentioning

confidence: 99%

Direct Medical Cost of Stroke and the Cost-Effectiveness of Direct Oral Anticoagulants in Atrial Fibrillation-Related Stroke: A Cross-Sectional Study

Azahar

Sulong

Zaidi

et al. 2022

IJERPH

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Background: Stroke has significant direct medical costs, and direct oral anticoagulants (DOACs) are better alternatives to warfarin for stroke prevention in atrial fibrillation (AF). This study aimed to determine the direct medical costs of stroke, with emphasis on AF stroke and the cost-effectiveness of DOACs among stroke patients in a tertiary hospital in Malaysia. Methods: This study utilised in-patient data from the case mix unit of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 2011 and 2018. Direct medical costs of stroke were determined using a top-down costing approach and factors associated with costs were identified. Incremental cost effectiveness ratio (ICER) was calculated to compare the cost-effectiveness between DOACs and warfarin. Results: The direct medical cost of stroke was MYR 11,669,414.83 (n = 3689). AF-related stroke cases had higher median cost of MYR 2839.73 (IQR 2269.79–3101.52). Regression analysis showed that stroke type (AF versus non-AF stroke) (p = 0.013), stroke severity (p = 0.010) and discharge status (p < 0.001) significantly influenced stroke costs. DOACs were cost-effective compared to warfarin with an ICER of MYR 19.25. Conclusions: The direct medical cost of stroke is substantial, with AF-stroke having a higher median cost per stroke care. DOACs were cost effective in the treatment of AF-related stroke in UKMMC.

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Atrial Fibrillation as an Ischemic Stroke Clinical and Economic Burden Modifier: A 15-Year Nationwide Study

Cited by 19 publications

References 72 publications

Health records as the basis of clinical coding: Is the quality adequate? A qualitative study of medical coders’ perceptions

Health records as the basis of clinical coding: Is the quality adequate? A qualitative study of medical coders’ perceptions

Citicoline affects serum angiostatin and neurospecific protein levels in patients with atrial fibrillation and ischemic stroke

Direct Medical Cost of Stroke and the Cost-Effectiveness of Direct Oral Anticoagulants in Atrial Fibrillation-Related Stroke: A Cross-Sectional Study

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