Thrombosis

Each year around 75,000 Americans are diagnosed with atrial fibrillation (AF), 900,000 experience a venous thromboembolism event (VTE), and 800,000 have a stroke. The burden for those who survive is enormous and the cost of care a major expense for individuals and the nation. Fortunately research advances are offering significant hope. A number of investigative anticoagulants have the potential to reduce strokes in AF patients while also reducing the risk of bleeds; clot-dissolving agents are proving to lessen the effects of strokes; and the same drugs in the pipeline for AF could prevent VTE after major orthopedic surgery.  This volume of The Silver Book was produced with educational support from Daiichi-Sankyo.

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    • Hospitalization costs for patients with nonrecurrent ischemic stroke
      The cost of hospitalization for patients with nonrecurrent ischemic stroke is $4,991 more in patients with atrial fibrillation, than in patients without the disease.        
    • Hospital costs for ischemic stroke
      Hospital costs for nonrecurrent ischemic stroke are 20% higher in patients with atrial fibrillation, than in patients without the disease.  
    • Annual strokes from AFib
      Atrial fibrillation accounts for between 75,000 and 100,000 strokes per year.  
    • Atrial fibrillation increases stroke risk
      Atrial fibrillation increases the risk of stroke 5- fold.  
    • Atrial Fibrillation prevalence increase from 1992 to 2002
      Among Medicare patients ages 65 and older, atrial fibrillation prevalence increased from 3.2% in 1992 to 6.0% in 2002–with higher prevalence in older patients.  
    • Atrial fibrillation prevalence projection, 2050
      Atrial fibrillation prevalence is projected to rise to between 5.6 and 12.1 million in 2050.  
    • Atrial fibrillation on death certificates
      In 2008, atrial fibrillation was mentioned on 99,294 death certificates in the U.S. and was the underlying cause of death in 15,383.  
    • AFib attributed stroke rate by age
      The percentage of strokes attributable to atrial fibrillation increases from 1.5% at ages 50 to 59, to 23.5% at ages 80 to 89.  
    • Atrial fibrillation incidence in women
      Atrial fibrillation in women ranged from 6.6 per 100,000 people per year for patients between the ages of 15 and 44 to 1,203.7 per 100,000 people per year for patients…  
    • Atrial fibrillation as the primary discharge diagnosis rates
      Atrial fibrillation was listed as the primary discharge diagnosis in 20.6 per 100,000 people per year for patients between the ages of 15 and 44 and 1,077.4 per 100,000 people…  
    • Average age of AFib patients
      The mean age for atrial fibrillation is 66.8 years in men and 74.6 years in women.  
    • Atrial fibrillation prevalence, 2012
      Atrial fibrillation is estimated to impact between 2.7 and 6.1 million Americans.  
    • Savings associated with t-PA treatment for ischemic stroke patients
      A $600 net savings is associated with each ischemic stroke patient treated with t-PA. In 2005, only 2% of all ischemic stroke patients received t-PA. If that percentage was increased…  
    • Stroke prevention through optimal anticoagulation
      If half of atrial fibrillation patients who currently receive warfarin in a routine care setting had their anti-coagulation optimized, around 9,000 strokes and more than 29,000 bleeds would be prevented.  
    • Effect of optimal anticoagulation
      If 50% of atrial fibrillation patients who currently receive warfarin in routine medical care were optimally anticoagulated, 9,852 emboli would be prevented and $1.3 billion would be saved each year.  
    • Effects of optimal anticoagulation among AFib patients
      If 50% of individuals with atrial fibrillation who do not receive prophylaxis were optimally anti-coagulated, 19,380 emboli would be prevented and $1.1 billion would be saved each year.  
    • Cost-savings associated with optimal anticoagulation in AFib patients
      If half of all atrial fibrillation patients receiving suboptimal or no anticoagulation instead received optimal anticoagulation, 28,000 strokes could be prevented each year at a savings of around $2.5 billion in direct…  
    • Effectiveness of treating ischemic strokert-PA within 3 hours of symptom onset
      A study of the  victims with effectiveness of treating ischemic strokert-PA within 3 hours of symptom onset showed a decrease in rehabilitation costs of $1.4 million and nursing home costs of…  
    • t-PA cost savings
      The total annual benefit to society from t-PA use in the United States is around $363 million—$60 million in direct cost savings to society plus an additional 7,510 QALYs. This means…  
    • Per-patient annual cost of treating stroke in atrial fibrillation patients
      The per-patient annual cost of treating stroke in atrial fibrillation patients was found to be $1,485 in a wellcontrolled anti-coagulation clinic, $3,710 for those receiving warfarin in routine medical care,…  
    • Cost of warfarin therapy for AFib patients
      In patients with nonvalvular atrial fibrillation (AF) and one additional stroke risk factor, warfarin therapy cost $8,000 per quality-adjusted life-year (QALY) saved.  
    • Cost-savings associated with Warfarin use in AFib patients
      Warfarin use in Medicare patients with nonvalvular atrial fibrillation was independently associated with lower medical costs averaging $9,836 per patient, per year.  
    • AFib practice guidelines reduce direct health care costs
      The use of practice guidelines in atrial fibrillation (AF) patients significantly decreased hospitalization and resource utilization—with an average decrease in 30-day total direct health care costs of around $1,400 per patient.  
    • Effectiveness of an oral pharmacologic agent in preventing venous thrombosis
      An oral pharmacologic agent has been demonstrated to be at least as effective as an injectable anticoagulant in the prevention of venous thrombosis following hip replacement.  
    • Direct thrombin inhibitor reduced relative risk of venous thromboembolism
      An investigational direct thrombin inhibitor reduced relative risk of venous thromboembolism after total hip replacement surgery by 65.7%—compared to a currently available treatment.  
    • Anti-platelet therapy stroke risk reduction
      Anti-platelet therapy after a stroke or TIA reduces the risk of nonfatal ischemic strokes by 28% and fatal strokes by 16%.  
    • Aspirin as stroke prevention
      Aspirin reduces stroke rate by 20% in patients with myocardial infarction.  
    • Pioglitazone associated with relative risk reduction in recurrent stroke
      The PROactive trial to manage glucose in diabetics with a history of cardiovascular disease, stroke, or other vascular risk factors found that treatment with pioglitazone was associated with a 47% relative…  
    • Antihypertensive drugs used to reduce stroke recurrence
      Treatment of high blood pressure with antihypertensive drugs is associated with a significant reduction in risk of recurrent stroke.  
    • Lowering blood pressure associated with reduction in stroke risk
      Lowering of blood pressure is associated with a 30% to 40% reduction in stroke risk.  
    • Effectiveness of treating ischemic stroke victims with rt-PA within 3 hours of symptom onset
      A study of the effectiveness of treating ischemic stroke victims with rt-PA within 3 hours of symptom onset found an estimated impact on long-term health outcomes of 564 quality-adjusted life-years saved…  
    • Identifying individuals at high risk for developing AFib
      Using simple bedside measures, identification of individuals at risk for developing atrial fibrillation is feasible. Selecting high-risk individuals for inclusion in atrial fibrillation prevention trials may also enhance prevention strategies.  
    • Catheter ablation reduces risk of stroke and death among AFib patients
      Atrial fibrillation patients who underwent catheter ablation had a reduced risk of stroke and death—2.2% of those who had ablation experienced stroke versus 4.7% on medications alone, and 6% died from…  
    • Decrease in AFib hospitalization rates
      The use of practice guidelines in atrial fibrillation patients saw a decrease in rate of hospitalization from 74%to 38%.  
    • Stroke risk reduction from thrombin inhibitor in AFib patients
      A recently approved direct thrombin inhibitor was found to reduce the risk of stroke/peripheral embolic events in atrial fibrillation patients by 34%, and the risk of hemorrhagic stroke by 74%—compared…  
    • Adjusted-dose warfarin reduced stroke risk in AFib patients
      Meta-analysis of randomized trials found that adjusted-dose warfarin reduced stroke risk in atrial fibrillation patients by 60%. Antiplatelet agents reduced risk by 20%.  
    • Aspirin use in AFib patients
      Meta-analysis of a number of randomized controlled trials found that aspirin use in atrial fibrillation patients reduced stroke risk by an average 22%.  
    • Stroke rates among Afib patients
      In one year, 58,283 of the 1.265 million Medicare beneficiaries with atrial fibrillation that did not receive prophylaxis suffered a stroke. For those who did receive anti-coagulants, 38,468 suffered strokes.  
    • Predicted incidence of VTE, 2050
      The incidence of VTE is predicted to more than double by 2050—from 0.95 million in 2006 to 1.82 million in 2050.  
    • AFib patients over age 80, 2050
      By 2050, it is estimated that more than 50% of Americans with atrial fibrillation will be age 80 and older.  
    • AFib prevalence rate projection, 2050
      By 2050, it is estimated that 88% of Americans with atrial fibrillation will be age 65 and older.  
    • Projected AFib incidence, 2050
      If current incidence estimates are applied to Census Bureau projections, by 2050 the number of Americans with atrial fibrillation could exceed 12 million. If increases in incidence continue, that number could…  
    • AFib prevalence projected to double by 2050
      By 2050, the prevalence of atrial fibrillation will have more than doubled since 2001—growing to an estimated 5.6 million to 12.1 million Americans.  
    • Annual AFib-related stroke Medicare costs
      Stroke in Medicare patients with atrial fibrillation who were not treated with anticoagulants, cost Medicare $4.8 billion each year in direct costs. Those who had strokes despite prophylactic treatment cost an additional…  
    • Difference in inpatient care costs between hip-fracture repair patients
      The difference in inpatient care costs between patients who developed venous thromboembolism after orthopedic surgery and those who didn’t, was highest among those who underwent hip-fracture repair. Costs were $10,000 to $13,000…  
    • Inpatient costs for VTE versus no VTE event
      The mean total cost for inpatient care of patients who develop in-hospital venous thromboembolism (VTE) after orthopedic surgery is almost double compared to those who don’t develop VTE—$17,114 for deep vein thrombosis…  
    • Annual cost of treating privately insured patients for AFib
      The annual cost of treating privately insured patients for atrial fibrillation (AF) is $12,350 per patient— approximately 5 times greater than treating patients without AF.  
    • Healthcare costs of atrial fibrillation
      Atrial fibrillation (AF) is a major economic burden for society with the biggest cost driver being hospitalizations—accounting for 52% of costs. Drugs for AF account for 23% of costs, consultations…  
    • Annual cost of AFib-related stroke in Medicare patients
      The annual cost of stroke in Medicare patients with atrial fibrillation is estimated at $8 billion.  
    • Total medical costs for Afib patients over 15-month period
      A study of Medicare beneficiaries with atrial fibrillation found that total medical costs for treating these patients during a 15-month follow-up period were an average of $24,000 per patient—63% of…  
    • Cost of AFib-related stroke in Medicare patients
      The incremental treatment costs associated with stroke in the year following diagnosis of atrial fibrillation are an estimated $7,907 per Medicare patient.  
    • One-Year Cost Component for Atrial Fibrillation & Non AF Medicare Patients
      One-Year Cost Component for AF & Non AF Medicare Patients  
    • AFib Medicare cost
      Medicare alone is estimated to pay $15.7 billion per year to treat newly diagnosed atrial fibrillation patients.  
    • Atrial fibrillation costs
      Around 73% of total U.S. atrial fibrillation costs are for inpatient expenses.  
    • Distribution of inpatient and selected outpatient costs for treating atrial fibrillation
      Distribution of inpatient and selected outpatient costs for treating atrial fibrillation  
    • Direct medical costs for treatment of atrial fibrillation, 2001
      The direct medical costs for ambulatory and outpatient treatment of atrial fibrillation patients in 2001 was  an estimated $1.76 billion. Office visits accounted for 66% of those costs, emergency department…  
    • Estimated hospital costs for atrial fibrillation patients, 2001
      The estimated costs for hospitalization of atrial fibrillation (AF) patients in 2001 were $2.93 billion for patients with AF as their primary discharge diagnosis.  
    • AFib treatment costs, 2001
      In 2001, the estimated treatment costs of atrial fibrillation were $6.65 billion per year—this included hospitalization costs, in- and out-patient care, and medications. This did not include costs of stroke…  
    • Effect of hip and knee replacement surgeries on risk of VTE
      Hip and knee replacement surgeries significantly raise the risk of venous thromboembolism—without prophylaxis around half develop deep vein thrombosis and 1% to 2% develop pulmonary embolism.  
    • Average length of stay in intensive care for VTE patients after surgery
      The mean length of stay in the intensive care unit for patients hospitalized after major orthopedic surgery  was roughly ten times longer for patients who developed venous thromboembolism.  
    • Average length of hospital stay for VTE patients after surgery
      The mean length of stay for patients hospitalized after major orthopedic surgery was more than twice as  long for patients with venous thromboembolism (VTE)—as compared to those without VTE. VTE…  
    • Venous thromboembolism hospitalization rates
      An estimated 250,000 patients are hospitalized each year with venous thromboembolism.  
    • Venous thromboembolism (VTE) outcomes
      Of the more than 200,000 new cases of venous thromboembolism (VTE) that occur each year, 30% die within 30 days, 20% suffer a sudden death from pulmonary embolism, and around…  
    • Symptomatic venous thromboembolism outcomes
      Around one-third of patients with symptomatic venous thromboembolism manifest pulmonary embolism. Two-thirds manifest deep vein thrombosis alone. Death occurs within 1 month of diagnosis in approximately 6% of deep vein…  
    • Venous thromboembolism in the community
      More than 50% of all cases of venous thromboembolism in the community can be attributed to institutionalization.  
    • Undetected pulmonary embolism
      More than 59% of the 300,000 people who die from venous thromboembolism in the U.S. each year have undetected pulmonary embolism.  
    • In-hospital deaths caused by venous thromboembolism
      The number of in-hospital deaths that are caused by venous thromboembolism is more than five times the number of deaths caused by all hospital-acquired infections.  
    • Venous thromboembolism in hospital mortality rate
      About 1 in 8 patients who develop venous thromboembolism in the hospital will die as a result.  
    • Venous thromboembolism mortality rate
      Venous thromboembolism causes an estimated 300,000 deaths each year.  
    • Depression and anxiety in AFib patients
      Around 1/3 of atrial fibrillation patients have elevated levels of depression and anxiety.  
    • Hospital readmission rates among AFib patients
      In the year following initial hospitalization for atrial fibrillation (AF), 12.5% of chronic AF patients were readmitted for AF—17.6% of readmissions occurred within 1 month. Among newly-diagnosed patients, 10.1% were…  
    • AFib patient hospital visits
      Individuals with atrial fibrillation (AF) are 4 times more likely to visit the hospital 3 or more times in the year following an AF diagnosis—compared to those without the disease.  
    • Medical care rates during the year following an AFib diagnosis
      A study of Medicare beneficiaries found that during the year following an atrial fibrillation (AF) diagnosis: • 28% of AF patients (versus 7% of non-AF patients) had 3 or more hospital…  
    • Medical care associated with atrial fibrillation, 2001
      In 2001, atrial fibrillation was the cause of around: • 350,000 hospitalizations • 5 million office visits • 276,000 emergency department visits • 234,000 out-patient visits  
    • AFib strokes occurring in patients 75+
      Close to half of all atrial fibrillation associated strokes occur in patients age 75 and older.  
    • The risk of stroke attributable to atrial fibrillation by age
      The risk of stroke attributable to atrial fibrillation increases from 1.5% for those ages 50 to 59 to 23.5% for those ages 80 to 89.  
    • Atrial fibrillation stroke risk
      Atrial fibrillation (AF) increases the risk of severe and recurrent ischemic stroke. Patients not treated with anticoagulants have a 2.1-fold increase in risk of recurrent stroke and 2.4-fold increase in…  
    • Atrial fibrillation stroke rates, 1991
      Atrial fibrillation accounts for between 75,000 and 100,000 strokes per year.  
    • Ischemic strokes caused by AFib
      Atrial fibrillation is responsible for at least 15% to 20% of all ischemic strokes.  
    • Risk of ischemic stroke in AFib patients
      The risk of ischemic stroke in nonvalvular atrial fibrillation patients is 2 to 7 times (200% to 700%) greater than in those without the disease.  
    • Heart failure rates among AFib patients
      A study of Medicare beneficiaries found that those with atrial fibrillation (AF) were significantly more likely to experience heart failure than their non-AF counterparts (36.7% versus 10.4%).  
    • Primary diagnoses for AFib patients
      Heart failure was listed as the primary diagnosis for 11.8% of patients hospitalized with atrial fibrillation (AF). Coronary heart disease was listed for 9.9% of AF patients, and stroke was…  
    • Most common causes of death after AFib diagnosis
      Within the first 4 months of diagnosis of atrial fibrillation, the most common cause of cardiovascular deaths are coronary artery disease (22%), heart failure (14%), and ischemic stroke (10%). After…  
    • Medicare beneficiaries AFib mortality rate
      Of Medicare beneficiaries who receive an atrial fibrillation diagnosis, 1 in 4 will die within a year.  
    • Atrial fibrillation doubles mortality risk
      Atrial fibrillation is associated with an approximate doubling of mortality risk.  
    • Atrial fibrillation as a contributory cause of death
      Around 84% of all deaths with atrial fibrillation as a contributory cause are in individuals age 75 and older.  
    • Atrial fibrillation as a contributory cause of death, 2011
      Atrial fibrillation is a contributory cause of death for around 93,000 Americans each year.  
    • Annual incidence of all thromboembolism
      Annual incidence of all thromboembolism, deep vein thrombosis (DVT) alone, and plumonary embolism  (PE) with or without deep vein thrombosis (PE ± DVT) among residents of Olmsted County, Minnesota, from…  
    • Incidence of venous thromboembolism increases with age
      Incidence of venous thromboembolism increases significantly with age—from less than 5 cases per 100,000 people ages 15 and younger, to around 500 cases per 100,000 people ages 80 and older.  
    • Prevalence of Diagnosed Atrial Fibrillation Stratified by Age and Sex
      Prevalence of Diagnosed Atrial Fibrillation Stratified by Age and Sex  
    • Lifetime risk of atrial fibrillation
      At age 80, the remaining lifetime risk of atrial fibrillation is around 22%.  
    • AFib rates by age
      Around 82% of Americans with atrial fibrillation are age 65 and older. Around 37% are age 80 and older.  
    • Atrial fibrillation prevalence by age, 2001
      Atrial fibrillation affects around 1 in 25 Americans age 60 and older, increasing to close to 1 in 10 adults by age 80.  
    • Atrial fibrillation prevalence doubles with age
      Atrial fibrillation prevalence doubles with each decade of age—reaching close to 9% by age 80.  
    • Median age AFib patient
      The median age of people with atrial fibrillation is about 75 years.  
    • VTE among hospitalized and nursing home residents
      Around 60% of all venous thromboembolism cases are in hospitalized patients and nursing home residents.  
    • VTE incidence, 2003
      Venous thromboembolism occurs for the first time in around 100 per 100,000 people each year.  
    • Venous thromboembolism event incidence
      Around 200,000 of the venous thromboembolism events each year are new cases.  
    • Annual venous thromboembolism events
      More than 900,000 incident or recurrent, fatal and nonfatal, venous thromboembolism events occur each year.  
    • Atrial fibrillation prevalence, 2001
      An estimated 2.66 million Americans currently have atrial fibrillation.  
    • AFib prevalence, 2006
      As much as 1% of the U.S. population is estimated to have atrial fibrillation  
    • Lifetime risk of developing atrial fibrillation for men and women
      The lifetime risk of developing atrial fibrillation is around 1 in 4 for both men and women age 40 and older.  
    • Atrial Fibrillation is Increasingly Prevalent in the United States
      Atrial Fibrillation is Increasingly Prevalent in the United States  
    • Atrial fibrillation ablation prevents recurrence of AFib
      Atrial fibrillation ablation, which involves using a catheter inserted into the heart to destroy electrical conduction tissue in or near the atria, prevents the recurrence of atrial fibrillation in up…  
    • Atrial fibrillation prevalence, 2007
      An estimated 2.2 million Americans have atrial fibrillation and most are over the age of 65.  
    • Effectiveness of pacemaker/defibrillators to control AFib
      Widespread use of pacemaker/defibrillators to control atrial fibrillation could result in a 50% decrease in stroke.