Treatment Of Irregular Heartbeat Saves Money And Prevents Stroke In Older People

September 03, 1998

DALLAS, September 4 -- Using a blood-thinning drug to treat people who have an irregular heartbeat is not only medically effective, but also cost-effective, according to a study in this month's Stroke: Journal of the American Heart Association.

The people who seemed to show the most benefit from taking warfarin, a blood thinner which helps stop blood from clotting, were older individuals who suffer from atrial fibrillation -- an irregular heartbeat which increases a person's stroke risk. The researchers said they believe this finding to be especially important, since people over 75 years old are at highest risk for having a stroke.

"For medical and economic reasons, anticoagulation treatment in the prevention of stroke is justified," says Sara Lightowlers, M.R.C.P., M.Sc., of the department of geriatric medicine, St. Andrew's Hospital, London, England.

"Although older patients are more at risk for problems such as bleeding in the brain, these data show that the treatment is most cost-effective in this group." Atrial fibrillation occurs when the two small upper chambers of the heart quiver instead of beating effectively. Blood isn't pumped completely out when the heart beats, allowing blood to pool and clot. If a piece of the blood clot blocks a blood vessel to the brain, a stroke results. According to the American Heart Association, about 15 percent of strokes occur in people with atrial fibrillation.

The researchers used data collected on about 4,000 people who participated in five different studies which examined the usefulness of blood-thinners to treat people with irregular heartbeats. They found it was far less expensive to the nation's healthcare system to treat people with warfarin and help prevent stroke than it was to not treat and have strokes occur.

For example, in the oldest group of people with atrial fibrillation -- those over 75 -- it was nearly five times more expensive not to treat patients with blood-thinning drugs. In the group treated with warfarin, the estimated cost of treatment -- even considering hospitalization stemming from bleeding in the brain -- would have cost just over $540,000 over a 10-year period.

The researchers estimated the group not treated with warfarin -- a group more likely to have strokes, long hospital stays and extensive rehabilitation -- would have a total cost of $2.4 million over the same 10-year span.

"Even if you figure a higher number than expected group of patients who develop bleeding in the brain, there is still a substantial monetary savings realized by treating their atrial fibrillation," says Lightowlers. "However, we are convinced that stroke treatment costs in the United States would be quite different than what we studied."

In addition to the overall cost, the researchers looked at quality of life issues, such as the number of years people were able to remain free of stroke after beginning treatment for their irregular heartbeat. They also looked at the cost per each year gained.

Again, the oldest group was shown to be the most cost-effective as there was an actual savings to the overall healthcare system of nearly $650 per year of life gained.

"These findings are consistent with other economic analyses," says Lightowlers. "There was a cost savings, especially when you look at the years of life gained, and only a minimal health advantage, but higher cost, in low-risk groups."

The researchers used data from the Boston Area Anticoagulation Trial for Atrial Fibrillation, the metaanalysis of five nonrheumatic atrial fibrillation studies and the Oxfordshire Community Stroke Project to develop their cost-effectiveness equations.

The study's co-author is Alistair McGuire, Ph.D.
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American Heart Association

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