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Prevalence of Congestive Heart Failure, Hypertension, Age (! 75 Years) (doubled), Diabetes Mellitus, Stroke (doubled), Vascular Disease, Age (65-74) Years, Sex Category (Female) (CHA 2 DS 2 -VASc) score in paroxysmal vs persistent atrial fibrillation (AF).
Source publication
Background
Atrial Fibrillation (AF) in Acute Ischemic Stroke (AIS) is considered a binary entity regardless of AF type. We aim to investigate in-hospital morbidity and mortality of non-paroxysmal AF related AIS.
Methods
Patients hospitalized for AIS with associated paroxysmal or persistent AF were identified from the 2018 National Inpatient Sample...
Context in source publication
Context 1
... difference in tissue plasminogen activator (tPA) use was seen between the 2 groups (P ¼ 0.1). Use of thrombectomy was more prevalent in the persistent AF group (P < 0.001). CHA 2 DS 2 -VASc scores were evenly distributed among the 2 admitted groups (paroxysmal AF, mean [M] 4.3, standard deviation [SD] 1.5; persistent AF, M 4.4, SD 1.6, P ¼ 0.1; Fig. 1). Baseline characteristics of permanent AF are listed in Supplemental Table ...
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Citations
... 10 The methodology of the NIS has been previously described 11,12 and the NIS has been used in the assessment of cost of care in previous studies. 13,14 The reporting of this manuscript is in accordance with the recommendations of the STROBE statement. 15 ...
Background:
Although observational studies have reported favorable clinical outcomes associated with intra-arterial thrombolysis as adjunct to mechanical thrombectomy, the cost and length of hospitalization associated with this intervention has not been studied.
Methods:
We analyzed the nationally representative data of the United States data from Nationwide Inpatient Sample (NIS) to compare hospitalization cost and duration in addition to other outcomes in patients receiving (n = 1990) with those not receiving intra-arterial thrombolysis (n = 1990) in acute ischemic stroke patients undergoing mechanical thrombectomy using a case control design matched for age, gender, and presence of aphasia, hemiplegia, neglect, coma/stupor, hemianopsia and dysphagia.
Results:
There was no difference in the median hospitalization cost in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: $36,992 [28,361 to 54,336] versus $35,440 [24,383 to 50,438], (regression coefficient 2,485 [-1,947 to 6,917], p = 0.27). There was no difference in the median length of hospitalization in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: 6 days [3 to 10] versus 6 days [4 to 10], (regression coefficient -0.34 [-1.47 to 0.80], p = 0.56). There was no difference in odds of home-discharge (OR 1.02 95%CI 0.72-1.43, p = 0.93) or post-procedural intracranial hemorrhage (OR 1.16 95%CI 0.83-1.64, p = 0.39) between the two groups.
Conclusions:
We did not observe an increase in the cost or length of hospitalization associated with the use of intra-arterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients. If the ongoing randomized clinical trials demonstrate therapeutic efficacy in reducing death or disability, this intervention has a high likelihood of being beneficial overall.
