Double jeopardy: Stroke after heart attack

Lifetime economic burden of stroke is $103,600

Heart attack patients who subsequently suffer a stroke incur a 56% increase overall in their medical bills. The higher cost is due to a combination of longer hospital stays and increased numbers of procedures such as head CT scans.

Chen Tung, MD, a cardiology fellow at the Duke Clinical Research Institute in Durham, NC, presented those findings at last year's meeting of the American Heart Association in Orlando, FL, and emphasized that most new therapies for heart attack - drugs such as thrombolytics and procedures such as angioplasties - carry risk of stroke.

In addition, 35% of such patients die during their initial hospitalization, and 50% have significant disability.

Tung's team analyzed data on 352 heart attack patients who suffered subsequent strokes and found the following:

The main cost driver for hospitalization was the stroke type - bleeding, $27,824, as compared to ischemic, $38,529.

The main cost driver for follow-up was level of disability at discharge.

Stroke patients were less likely to receive cardiac catheterization.

Stroke patients were less likely to receive angioplasty.

Stroke-related procedures added $2,180 per patient.

Stroke patients remained an additional 2.2 days in intensive care and an additional 3.1 days in hospital wards.

The net effect is an increase of $12,000 in initial hospitalization costs for stroke patients. After a six-month follow-up, costs were five times higher than those of nonstroke patients - $17,272 as compared to $3,543.

Data reported at the American Heart Association's (AHA) 23rd International Joint Conference on Stroke and Cerebral Circulation in February in Orlando, FL, reveal that pravastatin (Bristol-Myers Squibb's Pravachol) can significantly reduce the risk of a stroke or ministroke in heart attack patients.The new data expand previous findings that lowering cholesterol reduces the risk of a second attack and show that patients receiving the drug suffer fewer strokes.

Look at more numbers

Stroke costs the health care system more than $23 billion annually and costs an average of $103,600 over the lifetime of each victim. Thomas N. Taylor, PhD, at the University of Iowa College of Pharmacy in Iowa City, presented a computer simulation of stroke's lifetime economic burden at last year's International Joint Conference on Stroke and Cerebral Circulation in Anaheim, CA.1 Basing his work on Medicare and private insurance data, he reported the following:

The average lifetime cost of subarachnoid hemorrhage is $228,030; cost of an intracerebral hemorrhage is $123,565; and a clot stroke is $90,981. Indirect costs account for more than half of lifetime costs.

Forty-two percent of the lifetime cost is medical bills - hospitalization, rehabilitation, and nursing homes. The rest is lost earnings.

Strokes in the young are rare but expensive because of lost earnings. The lifetime cost is $475,000 in a 25 year old man; in an 85 year old woman it's $34,000.

The total lifetime cost of first-time strokes is $41 billion - $5.6 billion for subarachnoid hemorrhage, $6 billion for intracerebral hemorrhage, and $29 billion for ischemic stroke.

Stroke is the third leading cause of death in the United States and the No. 1 disabler of adults. Since patients who receive acute treatment to prevent disabilities are less likely to need extensive rehabilitation or care services later, money is saved over the long run.

Death rate for stroke still too high

In 1950 the death rate from stroke was 88.8%; in 1993, 26.9%. From 1984 to 1994 the rate declined by a fifth, yet stroke killed an estimated 154,350 people that year. (For related information, see graphs, at left.)

3,890,000 stroke survivors are alive today.

Current findings reveal that 731,000 people suffer a new or recurrent brain attack each year.

Stroke accounts for half of all patients hospitalized for acute neurological disease.

18% of annual brain attack victims are under age 65.

The 1993 death rates for stroke were 26.8 for white males and 52.0 for black males (94% higher); and 22.7 for white females and 39.9 for black females (75.8% higher).

Reference

1. Taylor TN, Davis PH, Torner JC, et al. Lifetime cost of stroke in the United States. Stroke 1996; 27:1,459-1,466.