Ischemic Stroke and Intracerebral Hemorrhage: The Latest Evidence on Mortality, Readmissions and Hospital Costs from Scotland

Abstract

Background and Purpose: Stroke is the third leading cause of death in the UK, yet little information exists on current treatment patterns, outcomes and costs. This study assessed survival, readmissions and total hospital costs over 12 months in patients with first-ever intracerebral hemorrhage (ICH) or ischemic stroke (IS) in Scotland. Methods: Hospital-based retrospective inception cohort design using data from the Hospital Record Linkage System in the National Health Service in Scotland. Survival, readmissions and total hospital costs were evaluated in all patients admitted to hospital for ICH or IS from April 1, 2004, to March 31, 2005. Results: A total of 1,016 patients with ICH and 4,295 with IS were identified. The average age was 67.6 years (SD 14.5) for ICH and 70.4 years (SD 12.7) for IS at stroke onset. In-hospital mortality was 45.2% (95% confidence interval, CI, 41.0–49.3) for ICH and 15.6% (95% CI, 14.4–16.7) for IS, while 52.5% (95% CI, 48.0–56.9) and 27.2% (95% CI, 25.7–28.8), respectively, were dead at 1 year after stroke onset. The cumulative 1-year risk of rehospitalization for stroke and severe cardiac events was 15.0 and 1.0% in the ICH cohort, respectively, and 10.8 and 1.5% in the IS cohort. The average length of initial hospital stay was 38.4 days for ICH and 39.3 days for IS. The average total hospital costs over 12 months were GBP 13,960 (SD 21,487) for ICH and GBP 14,051 (SD 17,850) for IS. Conclusion: Individuals experiencing an ICH continue to exhibit a much worse prognosis than IS, and both forms of stroke continue to imply significant hospital costs to the National Health Service in Scotland.

Cost-effectiveness analysis of stroke management under a universal health insurance system

“…The finding of half subjects incurring readmission or death during the first year after stroke was comparable or even higher than previous reports ranging from 31% to 53% [2][3][4][5]. It was noteworthy that the mortality rate of TIA/unspecified was low during initial hospitalization but the risk for first-year AE was unexpectedly high [40].…”

Medical Complications Among Hospitalizations for Ischemic Stroke in the United States From 1998 to 2007

“…11,12 These results suggest the longer LOS among hospitalizations with complications may contribute significantly to acute treatment cost. 23,24 Future studies are needed to examine the impact of decreased LOS on cost, quality of care, and long-term outcomes among ischemic stroke hospitalizations without complications.…”

Comparison of Post-Stroke Functional Recovery between Ischemic and Hemorrhagic Stroke Patients: A Prospective Cohort Study

“…In ischemic stroke, necrotic neuron persists despite the reperfusion that occurs, but, in hemorrhagic stroke, after blood is drained and intracranial pressure is relieved, neurons may recover.2 Therefore, prognosis of hemorrhagic stroke patients is largely influenced by duration of bleeding and size of hematoma. 7,10,11 Although hemorrhagic stroke has higher mortality and worse functional outcome than ischemic stroke, [3][4][5] hemorrhagic stroke patients who survive have better functional improvement than ischemic stroke. [6][7][8] From the result of this study, hemorrhagic stroke patients tended to be more severe on admission, yet they improved faster and had better final CNS scores (Figure 1).…”

“…3,5,12 Hemorrhagic stroke patients in this study consisted of only three patients, so those samples might not be representative of total hemorrhagic stroke population. This might be the reasonthis study did not reach significant statistical difference.…”

“…Hemorrhagic stroke is associated with higher mortality and worse functional impairment after stroke. [3][4][5] In term of recovery, earlier studies have found that after rehabilitation, hemorrhagic stroke is associated with better functional recovery than ischemic stroke. [6][7][8] However, there are many important factors other than stroke type that need to be considered in term of stroke prognosis.…”