Impact of Atrial Fibrillation on Inpatient Cost for Ischemic Stroke in the USA

Background: Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims: To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods: Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results: Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean ¼ $13,072, median ¼ $9270.87) significantly (p \u3c 0.0001) higher compared to all discharge records without ischemic stroke (mean ¼ $12,543.07, median ¼ $7517.13). The mean length of stay for all records was 4.55 days (95% CI ¼ 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI ¼ $2708–$2949) and mean length of stay was greater by 0.85 (95% CI ¼ 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions: The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population