Sex Disparities in the Direct Cost and Management of Stroke: A Population-Based Retrospective Study.

(1) Background: Previous studies have identified disparities in stroke care and outcomes by sex. Therefore, the main objective of this study was to evaluate the average cost of stroke care and the existence of differences in care provision by biological sex. (2) Methods: This observational study adhered to the recommendations of the STROBE statement. The calculation of costs was performed based on the production cost of the service or the rate paid for a set of services, depending on the availability of the corresponding information. (3) Results: A total of 336 patients were included, of which 47.9% were women, with a mean age of 73.3 ± 11.6 years. Women were typically older, had a higher prevalence of hypertension (p = 0.005), lower pre-stroke proportion of mRS 0-2 (p = 0.014), greater stroke severity (p < 0.001), and longer hospital stays (p = 0.017), and more were referred to residential services (p = 0.001) at 90 days. Women also required higher healthcare costs related to cardiovascular risk factors, transient ischemic strokes, institutionalization, and support needs; in contrast, they necessitated lower healthcare costs when undergoing endovascular therapy and receiving rehabilitation services. The unadjusted averaged cost of stroke care was EUR 22,605.66 (CI95% 20,442.8-24,768.4), being higher in women [p = 0.027]. The primary cost concept was hospital treatment (38.8%), followed by the costs associated with dependence and support needs (36.3%). At one year post-stroke, the percentage of women not evaluated for a degree of dependency was lower (p = 0.008). (4) Conclusions: The total unadjusted costs averaged EUR 22,605.66 (CI95% EUR 20,442.8-24,768.4), being higher in women compared to men. The primary cost concept was hospital treatment (38.8%), followed by the costs associated with dependence and support needs (36.3%).

The costs associated with stroke care continuum: a systematic review.

Stroke, a leading cause of death and long-term disability, has a considerable social and economic impact. It is imperative to investigate stroke-related costs. The main goal was to conduct a systematic literature review on the described costs associated with stroke care continuum to better understand the evolution of the economic burden and logistic challenges. This research used a systematic review method. We performed a search in PubMed/MEDLINE, ClinicalTrial.gov, Cochrane Reviews, and Google Scholar confined to publications from January 2012 to December 2021. Prices were adjusted using consumer price indices of the countries in the studies in the years the costs were incurred to 2021 Euros using the World Bank and purchasing power parity exchange rate in 2020 from the Organization for Economic Co-operation and Development with the XE Currency Data API. The inclusion criteria were all types of publications, including prospective cost studies, retrospective cost studies, database analyses, mathematical models, surveys, and cost-of-illness (COI) studies. Were excluded studies that (a) were not about stroke, (b) were editorials and commentaries, (c) were irrelevant after screening the title and abstract,(d) grey literature and non-academic studies, (e) reported cost indicators outside the scope of the review, (f) economic evaluations (i.e., cost-effectiveness or cost-benefit analyses); and (g) studies not meeting the population inclusion criteria. There may be risk of bias because the effects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 724 potential abstracts were identified of which 25 articles were pulled for further investigation. The articles were classified into the following categories: 1)stroke primary prevention, 2) expenditures related to acute stroke care, 3) expenditures for post-acute strokes, and 4) global average stroke cost. The measured expenditures varied considerably among these studies with a global average cost from €610-€220,822.45. Given the great variability in the costs in different studies, we can conclude that we need to define a common system for assessing the costs of strokes. Possible limitations are related to clinical choices exposed to decision rules that trigger decisions alerts within stroke events in a clinical setting. This flowchart is based on the guidelines for acute ischemic stroke treatment but may not be applicable to all institutions.

Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura / Organization and costs of stroke care in outpatient settings: Systematic review

Objetivo: Revisar la bibliografía sobre costes del ictus (ICD-10 código I63) en el ámbito de la atención primaria. Diseño: Revisión sistemática. Fuentes de datos: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit y Ovid/Embase entre el 1 de enero de 2012 y el 31 de diciembre de 2021 con descriptores incluidos en Medical Subject Heading (MeSH). Selección de estudios: Aquellos con descripción de costes de actividades realizadas en el ámbito extrahospitalario. Se incluyeron revisiones sistemáticas; estudios observacionales prospectivos y retrospectivos; análisis de bases de datos y de costes totales o parciales del ictus como enfermedad (COI). Se agregaron artículos utilizando el método de «bola de nieve». Se excluyeron los estudios: a) no relacionados concretamente con el ictus; b) en formato de editoriales o comentarios; c) irrelevantes después de examinar el título y el resumen; d) literatura gris y estudios no académicos. Extracción de datos: A los estudios se les asignó un nivel de evidencia según los niveles GRADE. Se recogieron datos de costes directos e indirectos. Resultados y conclusiones: Treinta estudios, de los que 14 (46,6%) eran relativos a costes postictus y 12 (40%) a costes en prevención cardiovascular. Los resultados muestran que la mayoría son análisis retrospectivos de diferentes bases de datos de atención hospitalaria a corto plazo, y no permiten realizar un análisis detallado de los costes por diferentes segmentos de servicios. Las posibilidades de mejora aparecen centradas en la prevención primaria y secundaria, selección y traslado prehospitalario, el alta precoz con soporte y la atención sociosanitaria.(AU)

Objective: To review the bibliography on stroke costs (ICD-10 code I63) in the field of primary care. Design: Systematic review. Data sources: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit, and Ovid/Embase between 01/01/2012–12/31/2021 with descriptors included in Medical Subject Heading (MeSH). Selection of studies: Those with a description of the costs of activities carried out in the out-of-hospital setting. Systematic reviews were included; prospective and retrospective observational studies; analysis of databases and total or partial costs of stroke as a disease (COI). Articles were added using the snowball method. The studies were excluded because: a) not specifically related to stroke; b) in editorial or commentary format; c) irrelevant after review of the title and abstract; and d) gray literature and non-academic studies were excluded. Data extraction: They were assigned a level of evidence according to the GRADE levels. Direct and indirect cost data were collected. Results and conclusions: Thirty studies, of which 14 (46.6%) were related to post-stroke costs and 12 (40%) to cardiovascular prevention costs. The results show that most of them are retrospective analyzes of different databases of short-term hospital care, and do not allow a detailed analysis of the costs by different segments of services. The possibilities for improvement are centered on primary and secondary prevention, selection and pre-hospital transfer, early discharge with support, and social and health care.(AU)

[Organization and costs of stroke care in outpatient settings: Systematic review]. / Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura.

OBJECTIVE: To review the bibliography on stroke costs (ICD-10 code I63) in the field of primary care. DESIGN: Systematic review. DATA SOURCES: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit, and Ovid/Embase between 01/01/2012-12/31/2021 with descriptors included in Medical Subject Heading (MeSH). SELECTION OF STUDIES: Those with a description of the costs of activities carried out in the out-of-hospital setting. Systematic reviews were included; prospective and retrospective observational studies; analysis of databases and total or partial costs of stroke as a disease (COI). Articles were added using the snowball method. The studies were excluded because: a) not specifically related to stroke; b) in editorial or commentary format; c) irrelevant after review of the title and abstract; and d) gray literature and non-academic studies were excluded. DATA EXTRACTION: They were assigned a level of evidence according to the GRADE levels. Direct and indirect cost data were collected. RESULTS AND CONCLUSIONS: Thirty studies, of which 14 (46.6%) were related to post-stroke costs and 12 (40%) to cardiovascular prevention costs. The results show that most of them are retrospective analyzes of different databases of short-term hospital care, and do not allow a detailed analysis of the costs by different segments of services. The possibilities for improvement are centered on primary and secondary prevention, selection and pre-hospital transfer, early discharge with support, and social and health care.

Prevalencia de la fibrilación auricular desconocida y la no tratada con anticoagulantes. Estudio AFABE / Prevalence of undiagnosed atrial fibrillation and of that not being treated with anticoagulant drugs: the AFABE study

Introducción y objetivos. La fibrilación auricular significa un grave problema de salud pública por sus complicaciones, por lo que su manejo debería incluir no sólo su tratamiento, sino también la prevención de las complicaciones tromboembólicas. El objetivo principal es conocer las proporciones de la fibrilación auricular desconocida y la no tratada con anticoagulantes. Métodos. Estudio observacional, transversal, retrospectivo, de base poblacional y multicéntrico. Se seleccionó aleatoriamente a 1.043 sujetos mayores de 60 años para realizarles un electrocardiograma en visita concertada. Se registraron variables sociodemográficas, valores en las escalas CHA2DS2-VASc y HAS-BLED, razón internacional normalizada y motivos de no recibir tratamiento anticoagulante oral. Resultados. La prevalencia total de fibrilación auricular fue del 10,9% (intervalo de confianza del 95%, 9,1-12,8%), de la que el 20,1% era desconocida. De la fibrilación auricular conocida, el 23,5% con un valor de CHA2DS2-VASc ≥ 2 no recibía tratamiento anticoagulante y el 47,9% tenía un valor HAS-BLED ≥ 3. La odds ratio de no recibir tratamiento anticoagulante fue 2,04 (intervalo de confianza del 95%, 1,11-3,77) para las mujeres, 1,10 (intervalo de confianza del 95%, 1,05-1,15) para la mayor edad de diagnóstico y 8,61 (intervalo de confianza del 95%, 2,38-31,0) si el valor de CHA2DS2-VASc es < 2. El deterioro cognitivo (15,2%) fue el motivo principal de no recibir tratamiento anticoagulante. Conclusiones. El 20,1% de las fibrilaciones auriculares de pacientes mayores de 60 años son desconocidas previamente y no se trata con anticoagulantes al 23,5% del total (AU)

Introduction and objectives. Atrial fibrillation constitutes a serious public health problem because it can lead to complications. Thus, the management of this arrhythmia must include not only its treatment, but antithrombotic therapy as well. The main goal is to determine the proportion of cases of undiagnosed atrial fibrillation and the proportion of patients not being treated with oral anticoagulants. Methods. A multicenter, population-based, retrospective, cross-sectional, observational study. In all, 1043 participants over 60 years of age were randomly selected to undergo an electrocardiogram in a prearranged appointment. Demographic data, CHA2DS2-VASc and HAS-BLED scores, international normalized ratio results, and reasons for not receiving oral anticoagulant therapy were recorded. Results. The overall prevalence of atrial fibrillation was 10.9% (95% confidence interval, 9.1%-12.8%), 20.1% of which had not been diagnosed previously. In the group with known atrial fibrillation, 23.5% of those with CHA2DS2-VASc≥2 were not receiving oral anticoagulant therapy, and 47.9% had a HAS-BLED score≥3. The odds ratio for not being treated with oral anticoagulation was 2.04 (95% confidence interval, 1.11-3.77) for women, 1.10 (95% confidence interval, 1.05-1.15) for more advanced age at diagnosis, and 8.61 (95% confidence interval 2.38-31.0) for a CHA2DS2-VASc score<2. Cognitive impairment (15.2%) was the main reason for not receiving oral anticoagulant therapy. Conclusions. The prevalence of previously undiagnosed atrial fibrillation in individuals over 60 years of age is 20.1%, and 23.5% of those who have been diagnosed receive no treatment with oral anticoagulants (AU)