Publications [#197863] of Daniel B. Mark

Papers Published

1. SV Rao, PR Kaul, L Liao, PW Armstrong, EM Ohman, CB Granger, RM Califf, RA Harrington, EL Eisenstein, DB Mark, Association between bleeding, blood transfusion, and costs among patients with non-ST-segment elevation acute coronary syndromes., American heart journal, vol. 155 no. 2 (February, 2008), pp. 369-74, ISSN 1097-6744 [doi]
   (last updated on 2011/11/29)

   Abstract:
   BACKGROUND: Bleeding and blood transfusion are associated with increased morbidity and mortality among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS); however, the economic consequences of these complications are not well defined. We sought to determine the relationship between bleeding, blood transfusion, and measures of costs among patients with non-ST-segment elevation ACS. METHODS: We analyzed data from the economic substudy of the GUSTO IIb trial (n = 1235) to determine the relationship between bleeding; transfusion; and hospital costs, physician costs, total costs, and length of stay. Linear regression models were developed to determine the cost implications of each bleeding and transfusion event. RESULTS: Of the patients in the economic substudy of GUSTO IIb, 36.8% (n = 455) experienced a bleeding event. As bleeding severity increased, there was a stepwise increase in length of stay (no bleeding 5.4 days, mild bleeding 6.9 days, moderate bleeding 15.0 days, severe bleeding 16.4 days; P < .01) and unadjusted total costs (no bleeding $14,282, mild $21,674, moderate $45,798, severe $66,564; P < .01). After adjustment for baseline differences among patients, each moderate or severe bleeding event increased costs by $3770 and each transfusion event increased costs by $2080. Further modeling demonstrated that the increase in costs was driven by increases in length of stay. CONCLUSIONS: Bleeding and transfusion are associated with increased resource use among patients with NSTE ACS. These data suggest that strategies that reduce both ischemia and the risk for bleeding have the potential to produce important reductions in the costs of care for patients with NSTE ACS.

   Keywords:
   Acute Coronary Syndrome • Adult • Aged • Blood Transfusion • Electrocardiography • Female • Fibrinolytic Agents • Health Care Costs* • Hematologic Agents • Hemorrhage • Hospital Costs • Humans • Length of Stay • Linear Models • Male • Middle Aged • Platelet Aggregation Inhibitors • adverse effects • adverse effects* • chemically induced • complications • drug therapy* • economics • economics* • therapeutic use • therapy