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Patients with recurrent stroke have poorer outcomes and higher care costs than those with a first stroke

Typically, patients who suffer a second or third stroke have poorer outcomes and greater costs than those who suffer a first stroke. Fewer of these patients survive, and those who do are more disabled. These are the findings of a study by the Stroke Prevention Patient Outcomes Research Team (PORT), which is supported by the Agency for Health Care Policy and Research (PORT contract 290-91-0028) and led by David B. Matchar, M.D., of Duke University.

The researchers found that 57 percent of first stroke survivors were alive 24 months after the stroke compared with only 48 percent of those who suffered a recurrent stroke. Costs were similar for the initial hospital stay and in the first 1 to 3 months after stroke. However, for months 4 to 24 after stroke, total costs were higher among those with recurrent stroke by about $375 per patient per month.

The difference was greatest for younger patients and least for patients aged 80 years and older. Most of the difference in total monthly cost was attributable to nursing home use (averaging about $150 per patient per month) and acute hospitalization (averaging about $120 per patient per month). Decision and cost-effectiveness models should use different estimates of survival and cost outcomes depending on whether the patient has a first or recurrent stroke, according to Dr. Matchar.

The researchers used administrative claims files from a random 20 percent sample of nearly 50,000 Medicare patients admitted to U.S. hospitals with a primary diagnosis of cerebral infarction during 1991. Data from hospitalizations during the previous 4 years were used to classify patients as having either first or recurrent stroke. Patients' survival and direct medical costs were followed for 24 months after stroke.

See "Epidemiology of recurrent cerebral infarction: A Medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost," by Gregory P. Samsa, Ph.D., John Bian, M.S., Joseph Lipscomb, Ph.D., and Dr. Matchar, in Stroke 30, pp. 338-349, 1999.

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