Epidemiology of recurrent cerebral infarction - A Medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost

Background and Purpose - Because recurrent strokes will tend to leave patie nts with greater disability than first strokes, patients with recurrent str okes should have poorer outcomes on average than those with first strokes. The extent of this difference has, however, not yet been estimated with pre cision. Methods - Using a random 20% sample of Medicare patients aged 65 years and older admitted with a primary diagnosis of cerebral infarction during calen dar year 1991, we used historical data from the previous 4 years to classif y patients as having either first or recurrent stroke and followed survival and direct medical costs for 24 months after stroke. First and recurrent s troke groups were compared with the log-rank test (survival) and t test (co st) and also multivariate modeling. Results - Survival from first stroke is consistently better than that for r ecurrent stroke: 24-month survival was 56.7% versus 48.3%, respectively. Co sts were similar for the initial hospital stay and in months 1 to 3 after s troke. During months 4 to 24 after stroke, total costs were higher among th ose with recurrent stroke by approximately $375/mo across all patients, wit h this difference being greatest for younger patients and least for patient s aged 80 years or older. Most of the difference in total monthly cost was attributable to nursing home utilization (averaging approximately $150/mo) and acute hospitalization (averaging approximately $120/mo). Conclusions - Patients with recurrent stroke have, on average, poorer outco mes than those with first stroke. To be as accurate as possible, clinical p olicy analyses should use different estimates of health and cost outcomes f or first and recurrent stroke.