Effects of stroke on medical resource use and costs in acute myocardial infarction

Background-Stroke occurs concurrently with myocardial infarction (MI) in ap proximate to 30 000 US patients each year. This number is expected to rise with the increasing use of thrombolytic therapy for MI. However, no data ex ist for the economic effect of stroke in the setting of acute MI (AMI). The purpose of this prospective study was to assess the effect of stroke on me dical resource use and costs in AMI patients in the United States. Methods and Results-Medical resource use and cost data were prospectively c ollected for 2566 randomly selected US GUSTO I patients (from 23 105 patien ts) and for the 321 US GUSTO I patients who developed non-bypass surgery-re lated stroke during the baseline hospitalization. Follow-up was for 1 year. All costs are expressed in 1993 US dollars. During the baseline hospitaliz ation, stroke was associated with a reduction in cardiac procedure rates an d an increase in length of stay, despite a hospital mortality rate of 37%, Together with stroke-related procedural costs of $2220 per patient, the bas eline medical costs increased by 44% ($29 242 versus $20 301, P<0.0001). Fo llow-up medical costs were substantially higher for stroke survivors ($22 4 00 versus $5282, P<0.0001), dominated by the cost of institutional care. Th e main determinant for institutional carl was discharge disability status. The cumulative I-year medical costs for stroke patients were $15 092 higher than for no-stroke patients. Hemorrhagic stroke patients had a much higher hospital mortality rate than non-hemorrhagic stroke patients (53% Versus 1 5%, P<0.001), which was associated with approximate to$7200 lower mean base line hospitalization cost. At discharge, hemorrhagic stroke patients were m ore likely to be disabled (68% versus 46%, P=0.002). Conclusions-In this first large prospective economic study of stroke in AMI patients, we found that strokes were associated with a 60% ($15 092) incre ase in cumulative 1-year medical costs, Baseline hospitalization costs were 44% higher because of longer mean lengths of stay. Stroke type was a key d eterminant of baseline cost, Follow-up costs were more than quadrupled for stroke survivors because of the need for institutional cars. Disability lev el was the main determinant of institutional care and thus of follow-up cos ts.