Open AccessAdditional Stroke-Related and Non–Stroke-Related Cardiovascular Costs and Hospitalizations in Managed-Care Patients After Ischemic Stroke
Author(s) -
C.S. Roberts,
Philip B. Gorelick,
Xin Ye,
Carolyn Harley,
George A. Goldberg
Publication year - 2009
Publication title -
stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.397
H-Index - 319
eISSN - 1524-4628
pISSN - 0039-2499
DOI - 10.1161/strokeaha.108.534354
Subject(s) - medicine , stroke (engine) , hazard ratio , proportional hazards model , cardiology , ischemic stroke , confidence interval , ischemia , mechanical engineering , engineering
Background and Purpose— Prior stroke confers an increased risk of future cardiovascular events. Because the incremental economic impact of this added risk is unknown, we assessed the additional cardiovascular costs and hospitalizations associated with ischemic stroke.Methods— Patients hospitalized for ischemic stroke during 2002 to 2005 were identified from a large US managed-care plan and matched to control patients hospitalized for a noncardiovascular acute event. Cumulative stroke-related and non–stroke-related cardiovascular medical costs were determined for each group. Stroke and nonstroke cardiovascular hospitalization rates were calculated with the Kaplan–Meier method; risk of hospitalization was estimated with a Cox regression model.Results— Stroke patients and matched controls (N=11 883) were identified (mean age ≈58 years; 47.8% female). Compared with controls, patients hospitalized for ischemic stroke had higher stroke and nonstroke cardiovascular medical costs at 6 months (stroke: $1756 vs $50,P <0.01; nonstroke cardiovascular: $1437 vs $658,P <0.01) and 12 months (stroke: $2109 vs $68,P <0.01; nonstroke cardiovascular: $2203 vs $1167,P <0.01) of follow-up. Among stroke patients, cumulative stroke and nonstroke cardiovascular hospitalization rates were 9.06% and 5.63% at 6 months, respectively, and 21.09% and 22.05% at 36 months, respectively. Stroke patients were at significantly increased risk of repeat stroke hospitalization (hazard ratio=12.55; 95% CI, 10.50 to 15.01) and nonstroke cardiovascular hospitalization (hazard ratio=1.95; 95% CI, 1.77 to 2.14).Conclusions— After ischemic stroke, patients have significantly greater stroke and nonstroke cardiovascular costs and hospitalizations than do matched controls. Attention to total cardiovascular risk reduction in this population could potentially reduce downstream costs.