Global Courant
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 cardiovascular deaths – and vascular diseases occur in low- and middle-income countries and are almost as common in men as in women. The WHO 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 percentage increase will be in the Eastern Mediterranean. The largest increase in deaths will occur in the Southeast Asian region.
The cost of CVD includes: Direct costs, including hospital care, prescription drug, doctor’s care, care in other facilities and ancillary health care expenses such as for other professionals, capital costs, public health, health research, etc.; plus indirect costs – include the value of lost economic output due to disability, both short and long term, or due to premature death; other costs include time lost to work and/or leisure time by relatives or friends caring for patients.
CVDs are a group of heart and blood vessel diseases, including:
• coronary artery disease – disease of the blood vessels that supply the heart muscle
• cerebrovascular disease – disease of the blood vessels that supply the brain
• hypertension – high blood pressure
• peripheral arterial disease – disease of the blood vessels supplying the arms and legs
• rheumatic heart disease – damage to the heart muscle and heart valves due to rheumatic fever, caused by streptococcal bacteria
• heart failure – a condition in which a problem with the structure or function of the heart interferes with the ability to supply enough blood to meet the body’s needs
• congenital heart disease – malformation of the heart structure at birth
• deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can break loose and travel to the heart and lungs.
Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a buildup of fatty deposits on the inner walls of the arteries that supply blood to the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or by blood clots.
The burden of cardiovascular disease should not be measured by deaths alone. CVD leads to overwhelming economic costs and human burden. Cardiovascular diseases have cost EU health systems just under $260 billion, representing a cost per capita of more than $500 a year, accounting for 10% of healthcare spending across the EU . When we look at these direct costs, the true costs of CVD are grossly underestimated. Production losses from death and disease amounted to $55 billion. The cost of informal care for CVD patients is another major non-health cost estimated at just under $60 billion. These are just the economic costs… the real cost in human terms of suffering and lost lives is incalculable.
According to the American Heart Association and the National Heart, Lung and Blood Institute, the staggering burden of CVD in the United States, including health care spending and lost productivity through death and disability, is expected to exceed $475 billion in 2009. By comparison, in 2008, the estimated cost of all cancers and benign tumors was $228 billion.
The economic burden of CVD is no longer limited to the affluent, industrialized world. With the exception of sub-Saharan Africa, cardiovascular disease is the leading cause of death in developing countries. The economic impact is felt both as a cost to health systems and as a loss of income and output for those directly affected by the disease and caregivers for people with CVD who retire.
This is exacerbated in developing countries, where cardiovascular disease affects a high proportion of working-age adults. In China, the direct costs are estimated to be more than $40 billion from 4% of gross national income. In South Africa, 25% of the country’s healthcare expenditure is spent on cardiovascular disease. Researchers have already estimated that 21 million years of future productive life are lost each year to cardiovascular disease among the emerging economies of Brazil, India, China, South Africa and Mexico. New studies suggest that obesity has recently surpassed smoking as the “largest modifiable risk factor” affecting how long and how well we live. Smoking has long been known as the number one cause of cardiovascular disease, lung cancer, emphysema and a host of other health problems. It is estimated that two-thirds of Americans are overweight, of which 50 percent are actually obese. Obesity is defined by the Mayo Clinic as “an excessive amount of body fat that is more than just a cosmetic problem.”
According to the Center for Disease Control (CDC), obesity increases the risk of heart disease, diabetes, cancer, hypertension (high blood pressure), stroke, sleep apnea and osteoarthritis. What is surprising is that obesity is gradually becoming a more common risk factor than smoking. For years we have been hearing about how smoking is the leading cause of a variety of diseases and life-threatening conditions such as lung cancer, emphysema and heart disease; however, recent studies have suggested that obesity is beginning to overshadow the risks of smoking and drinking combined – and at an alarming rate. In 2008 it was estimated that obesity cost the US $147 billion and in 2010 there shouldn’t be much delay. In fact, Thomson Reuters estimates that over the next few years, obese people will spend an average of 40 percent more on health costs — or $1,429 more per year than “normal weight” people. The most pervasive cost of CVD is related to the incidence of heart failure, which increases with age. In 2000, about 12.7 percent of the U.S. population was 65 or older. It is estimated that 16.5 percent will fall into this age group by 2020.
According to the CDC, 70 percent of U.S. residents with heart failure are age 60 or older, indicating that significant increases in heart failure prevalence are expected in the coming years. Ironically, success in treating heart attacks is another factor that has led to an increase in the number of people with heart failure. More effective treatments have resulted in improved survival rates after heart attacks. According to the CDC, more than 20 percent of men develop heart failure within six years of a heart attack. An even higher percentage (more than 40 percent) of women develop heart failure within that time after a heart attack. Together, the aging population and the improved medical outlook for heart attack victims account for the approximately three-fold increase in the annual incidence of heart failure observed over the past 10 years.
These factors will also increase the economic impact of heart failure. This is true, even though the survival of heart failure patients has improved with heart medication treatment. Human Cost Heart failure takes a price from patients and their families in terms of the extra difficulty patients have in carrying out normal daily activities. These human costs were thoroughly examined in a recent study by scientists at the University of Michigan Health System and the Veterans Administration Ann Arbor Healthcare System, based on survey responses from 10,626 heart failure patients age 65 and older. The study found that people with heart failure, compared to people without the condition:
• Much more likely to be disabled
• Much more likely to have problems with normal daily activities, even things like walking around the room
• More likely to be in nursing homes
• More likely to have been in a nursing home in the past two years
• More chance of home care
• More likely to have experienced clinical conditions more common in older adults (such as hurting themselves from a fall, urinary incontinence and dementia)
The main factor determining the cost of heart failure treatment is the high incidence of hospitalization. A large percentage of health care costs associated with heart failure result from the need to hospitalize patients. Patients with heart failure are at high risk of hospitalization. Results from a National Hospital Discharge Survey show that hospitalizations for heart failure have increased significantly, from more than 400,000 in 1979 to more than 1.1 million in 2004, accounting for nearly 2 percent of all hospitalizations in the United States.
According to the Centers for Disease Control, heart failure is the most common reason for hospitalization among people on Medicare. Readmission rates during the six months after discharge are as high as 50 percent. The top three causes of hospitalization in patients with heart failure are fluid retention (55 percent), angina (chest pain) or heart attack (25 percent), and irregular heart rhythms (15 percent). There is a growing need for effective treatment of fluid retention, not only to improve the prognosis of patients with heart failure, but also to improve their quality of life. Repeated hospitalizations are bad for a patient’s prognosis and quality of life and also cause higher healthcare costs.
In 2009 Dr. Eldon Smith in his presentation of Canada’s first comprehensive Heart Health strategy and action plan: “Cardiovascular disease (heart disease and stroke) is Canada’s No. 1 killer and public health threat, costing the economy more than $22 billion annually.” This represents over $600 for every man, woman and child without trying to quantify lost years, lost quality of life and lost love.
Cardiovascular diseases destroy us!
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