Santos João Vasco, Pereira João, Pinto Roberto, Castro Pedro Miguel, Azevedo Elsa, Freitas Alberto
Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal;; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.
Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
Value Health. 2017 Sep;20(8):1083-1091. doi: 10.1016/j.jval.2017.04.018. Epub 2017 Jun 21.
Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS). Patients with AF may undergo preventive therapy. Although the AF impact in the clinical burden of IS has been studied, information is lacking in Southern Europe and there are no studies about the impact in potential years of life lost. Moreover, no nationwide or long-term study analyzed the economic burden of IS stratified by AF.
To study the impact of AF in the clinical and economic burden of IS.
We conducted a retrospective study using nationwide administrative data for all public hospitalizations in mainland Portugal from 2000 to 2014. We considered IS hospitalizations stratified by the presence of AF as secondary diagnosis.
Of the total 275,173 IS hospitalizations, 22.6% reported AF. The total number of IS hospitalizations increased from 14,836 in 2000 to 19,561 in 2014 (32% increase), with an increase of 138% in the AF group (from 2,411 to 5,727). In-hospital mortality decreased from 13.6% to 11.5% and was consistently higher in the AF group (17.3% vs. 11.1%). Mean charges were also higher in the AF group (€2297 vs. €2191). Age-adjusted potential years of life lost rate was higher in the group without AF (39.6 vs. 7.5).
AF-associated IS hospitalizations more than doubled in the studied 15-year period. Also, AF was responsible for higher in-hospital mortality and hospitalization charges. These facts highlight the need for early detection of AF and preventive treatment to limit IS occurrence, its associated burden, and poorer health outcomes.
心房颤动（AF）是缺血性卒中（IS）的主要危险因素。房颤患者可能接受预防性治疗。尽管已经研究了房颤对缺血性卒中临床负担的影响，但南欧地区仍缺乏相关信息，并且没有关于潜在生命损失年数影响的研究。此外，没有全国性或长期研究分析按房颤分层的缺血性卒中的经济负担。
研究房颤对缺血性卒临床和经济负担的影响。
我们使用2000年至2014年葡萄牙大陆所有公立医院住院的全国行政数据进行了一项回顾性研究。我们将缺血性卒中住院病例按是否存在房颤作为次要诊断进行分层。
在总共275,173例缺血性卒中住院病例中，22.6%报告有房颤。缺血性卒中住院总数从2000年的14,836例增加到2014年的19,561例（增加了32%），房颤组增加了138%（从2,411例增加到5,727例）。住院死亡率从13.6%降至11.5%，房颤组始终较高（17.3%对11.1%）。房颤组的平均费用也更高（2297欧元对2191欧元）。无房颤组的年龄调整潜在生命损失年率更高（39.6对7.5）。
在研究的15年期间，与房颤相关的缺血性卒中住院病例增加了一倍多。此外，房颤导致更高的住院死亡率和住院费用。这些事实凸显了早期检测房颤和进行预防性治疗以限制缺血性卒中发生、其相关负担和较差健康结局的必要性。
