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Cardiovascular Disease is Killing Us!

By all indications, we are facing a global pandemic. Cardiovascular disease (CVD) is the cause of more than 50% of deaths, not only in developed countries, but the World Health Organization (WHO) estimates that low- and middle-income countries are disproportionately affected: 82% of CVD deaths In middle-income countries, the incidence is almost the same in men and women. The World Health Organization predicts that by 2030, nearly 23.6 million people will die from cardiovascular disease. These are expected to remain the leading causes of death. The largest increases will be seen in the Eastern Mediterranean region. Southeast Asia has seen the largest increase in deaths.

The costs of CVD include: Direct costs, including expenditures for hospital care, prescription drugs, physician care, other institutional care, and additional health expenditures for other professionals, capital costs, public health, health research, etc.; The value of economic output lost due to short-term or long-term disability or premature death; other costs may include the value of time lost to work and/or leisure activities for family members or friends caring for the sick person.

CVD is a group of diseases of the heart and blood vessels that include:

• Coronary heart disease – disease of the blood vessels that supply the heart muscle

• Cerebrovascular disease – disease of the blood vessels that supply the brain

• High blood pressure – high blood pressure

• Peripheral arterial disease – disease of the blood vessels that supply the arms and legs

• Rheumatic heart disease – damage to the heart muscle and valves caused by rheumatic fever caused by streptococcal bacteria

• Heart failure – a condition in which there is a problem with the structure or function of the heart that affects its ability to provide enough blood flow to meet the body’s needs

• Congenital heart disease – a structural abnormality of the heart at birth

• Deep vein thrombosis and pulmonary embolism – blood clots in the veins of the legs that can travel and travel to the heart and lungs.

Heart attacks and strokes are usually acute events, primarily caused by blockages that prevent blood flow to the heart or brain. The most common cause is a buildup of fatty deposits on the lining of blood vessels that supply the heart or brain. Strokes can also be caused by bleeding or blood clots in blood vessels in the brain.

The burden of cardiovascular disease should not be measured solely by the number of deaths. CVD results in enormous economic costs and human burdens. Cardiovascular disease costs the EU healthcare system just under US$ 260 billion, equivalent to an annual per capita cost of more than US$ 500 and accounting for 10% of EU healthcare expenditure as a whole. Looking at these direct costs grossly underestimates the true cost of CVD. Lost production from death and disease amounted to US$55 billion. The cost of informal care of CVD patients is another major non-medical cost estimated at less than $60 billion. It’s just the economic cost…the true cost of human suffering and loss of life is immeasurable.

According to the American Heart Association and the National Heart, Lung, and Blood Institute, the alarming burden of CVD in the United States in 2009, including healthcare spending and lost productivity from death and disability, was projected to exceed $475 billion. This compares with an estimated cost of US$ 228 billion for all cancers and benign neoplasms in 2008.

The economic burden of CVD is no longer a concern only for the wealthy industrialized world. CVD is the leading cause of death in developing countries, except in sub-Saharan Africa. The economic impact manifests itself both in costs to the health system and in lost income and productivity for those directly affected by the disease and for caregivers of CVD patients who stop working.

This is exacerbated by CVD affecting a large proportion of working-age adults in developing countries. In China, direct costs are estimated at more than $40 billion, or 4 percent of gross national income. In South Africa, 25% of the country’s healthcare spending is on CVD. Researchers have estimated that 21 million years of future productive life are lost each year to CVD among developing economies such as Brazil, India, China, South Africa, and Mexico. Obesity recently beat out smoking as the “largest modifiable risk factor” affecting how long we live and our quality of life, new research shows. Smoking has long been considered the number one cause of cardiovascular disease, lung cancer, emphysema, and a variety of other health problems. It is estimated that two-thirds of Americans are overweight, and 50% of them are actually obese. The Mayo Clinic defines obesity as “excess body fat that is not merely a cosmetic issue.”

According to the Centers for Disease Control (CDC), obesity increases the risk of heart disease, diabetes, cancer, hypertension (high blood pressure), stroke, sleep apnea, and osteoarthritis. Surprisingly, obesity is becoming a more prevalent risk factor than smoking. For many years we have heard that smoking is the number one cause of many ailments and life threatening diseases such as lung cancer, emphysema and heart disease; however, recent research shows that obesity is starting to outpace smoking and alcohol consumption at an alarming rate risks of. In 2008, the estimated cost of obesity was $147 billion, and 2010 should see little relief. In fact, Thomson Reuters estimates that over the next few years, obese people will spend an average of 40 percent more on medical bills, or $1,429 more per year than people in the “normal weight range.” The most prevalent cost of CVD is related to the increasing incidence of heart failure with age. In 2000, approximately 12.7 percent of the US population was 65 or older. It is estimated that by 2020, this age group will account for 16.5%.

According to the Centers for Disease Control and Prevention, 70 percent of U.S. residents with heart failure are age 60 or older, indicating that the prevalence of heart failure is expected to increase significantly in the coming years. Ironically, another factor contributing to the increase in the number of heart failure patients is the successful treatment of heart attacks. More effective treatment could improve survival after a heart attack. According to the CDC, more than 20 percent of men will develop heart failure within six years of a heart attack. A higher proportion (more than 40%) of women will develop heart failure in the time after a heart attack. The combination of an aging population and improving medical prospects for patients with heart disease has resulted in an approximately three-fold increase in the annual incidence of heart failure over the past decade.

These factors also increase the economic impact of heart failure. This is true even as survival rates for patients with heart failure have improved due to cardiac drug therapy. Human costs Heart failure imposes an additional cost on patients and their families, as patients experience more difficulty performing normal daily activities. Scientists at the University of Michigan Health System and the Veterans Administration’s Ann Arbor Health Care System recently took a closer look at this human cost, based on survey responses from 10,626 heart failure patients aged 65 and older. Research shows that, compared to people without heart failure, people with heart failure are:

• are much more likely to be disabled

• More likely to have difficulty with normal daily activities, even moving around the room

• More likely to be admitted to a nursing home

• More likely to have been in a nursing home within the past two years

• more likely to receive home care

• More likely to have experienced clinical conditions that are more common among older adults (such as hurting themselves from falls, urinary incontinence, and dementia)

The main factor determining the cost of treating heart failure is the high rate of hospitalization. A large portion of the health care costs associated with heart failure is due to the need for hospitalization. Patients with heart failure are at high risk of hospitalization. According to the National Hospital Discharge Survey, hospitalizations for heart failure have increased dramatically, from more than 400,000 in 1979 to more than 1.1 million in 2004, accounting for almost 2 percent of all hospitalizations in the United States.

Among people with Medicare, heart failure is the most common cause of hospitalization, according to the Centers for Disease Control. Readmission rates within six months of discharge are as high as 50%. The three leading reasons for hospitalization in patients with heart failure were fluid overload (55%), angina (chest pain) or heart attack (25%), and irregular heartbeat (15%). There is a growing need for effective treatment of fluid overload that would improve not only the prognosis but also the quality of life of patients with heart failure. Repeated hospitalizations predict poor patient prognosis and quality of life, and lead to increased healthcare costs.

Introducing Canada’s first comprehensive heart health strategy and action plan in 2009, Dr. Eldon Smith stated, “Cardiovascular disease (heart attack and stroke) is Canada’s number one killer and public health threat, costing the economy more than $220 Billions.” That represents over $600 per man, woman and child without attempting to quantify lost years, lost quality of life, and lost love.

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