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Eur J Prev Cardiol. 2019 Apr 6:2047487319834770. doi: 10.1177/2047487319834770. [Epub ahead of print]

Patient and caregiver productivity loss and indirect costs associated with cardiovascular events in Europe.

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1 Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK.
2 IQVIA, Zaventem, Belgium.
3 Amgen (Europe) GmbH, Rotkreuz, Switzerland.
4 Department of Neurology and Stroke Centre, Bichat Hospital, Paris, France.
5 University of Ghent, Belgium.



The aim of this study was to estimate patient and caregiver productivity loss and indirect costs following an acute coronary syndrome (ACS) or a stroke in Europe.


A cross-sectional study was conducted in seven European countries. A validated questionnaire was used during a cardiologist/neurologist visit 3-12 months post event. We included patients who returned to work ( ≥ 4 weeks prior to recruitment), given specific interest in presenteeism. Patient absenteeism, presenteeism and caregiver loss in the past four weeks were pro-rated to one year and combined with time-off due to initial hospitalisation/sick-leave. Hours lost were valued according to country labour cost (2018 euros).


The analysis included 196 ACS (86% myocardial infarction) and 198 stroke (99% ischaemic, 77% modified Rankin Scale 0-1) patients. Mean age in ACS and stroke patients was 53 years, 86% and 78% respectively were men, 28% and 25% had previous cardiovascular event or established cardiovascular disease. Mean (country range) total productivity time loss was 70 (47-91) workdays for ACS and 68 (45-88) workdays for stroke (25% of annual workdays). Particularly, ACS patient lost 59 (37-79) workdays, and caregivers lost 11 (0-16) workdays, with total mean indirect cost per case €13,953 (€6641-23,160). After stroke, 56 (42-70) workdays were lost by patient plus 12 (3-20) days by caregiver, amounting to €13,773 (€10,469-20,215). Patients with previous events or established cardiovascular disease lost 80 (ACS) and 73 (stroke) workdays, costing €16,061 and €14,942 respectively.


Our results suggest that lost productive time and indirect costs following ACS/stroke are substantial, with indirect costs comparable to direct costs.


Cardiovascular diseases; absenteeism; caregivers; cost of illness; presenteeism; productivity


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