Original Article
Incidence and Cost of Stroke and Hemorrhage in Patients Diagnosed with Atrial Fibrillation in France

https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.08.022Get rights and content

Background

Stroke represents a major complication of atrial fibrillation (AF). The current anticoagulation options for stroke prevention increase hemorrhage risk. The objective of the study was to estimate the incidence and costs of hospitalization for stroke and hemorrhage in patients with AF who are eligible for stroke prevention.

Methods

Patients hospitalized for AF were identified from the French National hospital database (Programme Médicalisé des Systèmes d’Information) and a calculated stroke risk score (congestive heart failure, hypertension [blood pressure consistently >140/90 mm Hg], age ≥75 years, diabetes mellitus, and previous stroke, transient ischemic attack [CHADS2]). Adult patients eligible for stroke prevention (CHADS2 >0) were enrolled. The incidence of hospitalization for stroke and hemorrhage was calculated over a 2-year period. Costs of acute care were determined using diagnosis related groups (DRGs) and corresponding National Hospital Tariffs. Rehabilitation costs were analyzed for patients with strokes and classified by stroke severity.

Results

Sixty-one thousand five hundred eighty-two patients were identified with a mean age of 75.0 ± 11.0 years and a mean CHADS2 score of 1.90 ± 0.99. The 24-month cumulative incidence of any stroke was 32.1 cases/1,000 patients with AF (ischemic, 60%; hemorrhagic, 24%; unspecified, 16%), and that of hemorrhage was 53.1 cases/1,000 patients with AF (gastrointestinal, 26%; intracranial, 5%; other, 69%). The mean costs of ischemic and hemorrhagic strokes were €4,848 and €7,183 (mild), €10,909 and €14,298 (moderate), €29,065 and €29,701 (severe), and €6,035 and €4,590 (fatal), respectively. The mean costs of hemorrhage by type were €3,601 (gastrointestinal), €7,331 (intracranial), €3,941 (other major), and €2,552 (nonmajor).

Conclusions

The incidence and cost of hospitalization for hemorrhage should be considered in the global burden of AF. These data should be useful for pharmacoeconomic evaluation of new oral anticoagulant medications. Such real-world studies may be relevant for monitoring mid- to long-term morbidity and mortality in the AF population.

Section snippets

Methods

This is a retrospective database cohort study of adult patients hospitalized for AF in France in 2008. From this index hospitalization date, data on medical history were extracted over the previous 2-year period (2006-2008) and events of interest (i.e., strokes, hemorrhages, and other cardiovascular events) were documented longitudinally over the subsequent 2-year period (2008-2010).

Patients

A total of 99,949 hospital stays with AF as the principal or related diagnosis were identified in France in 2008. These represented 84,603 patients who constituted the AF population. Of these, 61,582 (72.8%) fulfilled the eligibility criteria (age ≥18 years and CHADS2 score >0) and constituted the study population (Fig 1). This population was elderly (mean age, 75 years) and predominantly male (53% men). The mean CHADS2 score was 1.90 ± 0.99 (Table 1). The risk factors for stroke most

Discussion

This study presents real-world data on the epidemiology, hospital management care, and hospital costs related to stroke, hemorrhage, and other cardiovascular events over 2 years of follow-up from 2008 to 2010 in a population of 61,582 AF patients in France with ≥1 risk factor for stroke.

The incidence rates for stroke and hemorrhage in patients with AF documented in the PMSI databases can be compared with those observed in recent clinical trials of oral anticoagulants. Over the last 4years, 3

Acknowledgment

We thank Adam Doble (Foxymed SARL, Paris, France) for help with the preparation of this article.

Drs. Cotté and Gaudin are employees of Bristol-Myers Squibb, and Dr. Kachaner is an employee of Pfizer. Dr. Vainchtock is a partner with and Dr. Chaize an employee of HEVA Lyon, a Health Economics Consultancy, who received fees from Bristol-Myers Squibb and Pfizer for carrying out the data analysis. Dr. Durand-Zaleski has received consultancy fees from Bristol-Myers Squibb and Pfizer for her

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