The impact of ischaemic stroke on atrial fibrillation-related healthcare cost: a systematic review

Abstract

The aim of this study was to summarize healthcare costs incurred by patients with atrial fibrillation (AF) who developed ischaemic stroke, explore factors associated with increased cost, and highlight the importance of anticoagulation therapy for stroke prophylaxis. A systematic literature search of PubMed, EMBASE, Web of Science, and the health economic evaluation database was conducted up to December 2015. Studies focused on the cost and/or resource utilization of ischaemic stroke in patients with AF were included. Reported costs were converted to international dollars (I$) and adjusted to 2015 values. Alongside the narrative review of included studies, Spearman's correlation, independent-samples t-test, and one-way ANOVA were used to explore factors associated with cost differences between studies. Sixteen studies published from nine countries were identified. Based on currency conversion rates in 2015, ischaemic stroke-related healthcare costs were estimated to be I$41 420, I$12 895, and I$8184 for high-income, upper middle-income, and lower middle-income economies, respectively. Local GDP per capita accounted for ∼50% of the healthcare cost variation among countries. Major component of overall cost was from hospitalization. Ischaemic stroke incurring in patients with AF ≥75 years was 2.3 times that of their younger peers (P = 0.049). The economic burden from ischaemic stroke in patients with AF is considerable with positive association to country income. Clinicians and stakeholders should be aware of the importance of anticoagulation therapies in stroke prophylaxis, the occurrence of stroke, and the downstream economic burden on an increasingly ageing population.

Real‐world data on the incidence, mortality, and cost of ischaemic stroke and major bleeding events among non‐valvular atrial fibrillation patients in England

“…In 25 465 US NVAF patients studied between 1999 and 2009, the most significant costs of first ischaemic stroke/major bleeding occurred in the first year, but total healthcare costs remained elevated up to 3 years post‐event 21 . The considerable economic burden of ischaemic stroke in AF patients was also highlighted in a systematic review including 16 studies of ischaemic stroke costs and HRU in patients with AF across nine countries 22 . In agreement with our results, the major component of overall costs was hospitalization.…”

Apelin increases atrial conduction velocity, refractoriness, and prevents inducibility of atrial fibrillation

“…Atrial fibrillation (AF) is the most common clinical arrhythmia and is the leading cause of disabling stroke ( 1 ). As the prevalence of AF is increasing due to an aging population ( 2 ), AF exerts an increasing strain on the health care system ( 2 , 3 ). Current management of AF focuses on both medical and catheter ablation–directed strategies ( 4 ).…”

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

“…Even though several studies have analyzed costs for AF-related ischemic strokes, a lot of disparities are present in their methodologies, especially regarding cost calculation [25], resulting in unavoidable obstacles in making accurate comparisons. To our knowledge, only Sussman et al (United States) [8], Wang et al (United States) [26], and Ali et al (United Kingdom) [27] reported the costs for IS stratified by AF.…”