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Cardiovascular Disease is Killing Us!
By all indications, we are facing a global pandemic. Cardiovascular diseases (CVD) are 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 occur in low- and middle-income countries. middle income and appear almost equally in men and women. WHO predicts that by 2030, almost 23.6 million people will die from cardiovascular diseases. They are predicted to remain the leading single causes of death. The largest percentage increase will occur in the Eastern Mediterranean region. The largest increase in the number of deaths will occur in the Southeast Asian region.
CVD costs include: Direct costs which include expenditure on hospital care, prescription drugs, medical care, care in other institutions and additional health costs such as costs for other professionals, capital costs, public health, health research, etc.; plus indirect costs – include the value of economic output lost due to disability, whether short-term or long-term, or as a result of premature mortality; other costs may include the value of time lost to work and/or leisure activities of family members or friends caring for patients.
CVD is a group of heart and blood vessel disorders including:
• coronary heart 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 artery disease – disease of the blood vessels that supply the arms and legs
• rheumatic heart disease – damage to the heart muscle and valves from rheumatic fever, caused by streptococcal bacteria
• heart failure – a condition in which a problem with the structure or function of the heart reduces its ability to supply sufficient blood flow for the body’s needs
• congenital heart disease – a malformation of the heart structure that exists at birth
• deep vein thrombosis and pulmonary embolism – blood clots in the veins of the legs, which can dislodge and move to the heart and lungs.
Heart attacks and strokes are usually acute events and are generally caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is the accumulation of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. A stroke can also be caused by bleeding from a blood vessel in the brain or from blood clots.
The burden of CVD should not be measured only by deaths. CVD leads to enormous economic costs as well as human burden. CVD costs EU healthcare systems just under USD 260 billion, representing a per capita cost of more than USD 500 per year, accounting for 10% of healthcare expenditure across the EU. Looking at these direct costs greatly underestimates the true costs of CVD. Production losses due to death and disease amounted to USD 55 billion. The cost of informal care for CVD patients is another major non-health cost, estimated at just under US$60 billion. This is only the economic cost… the real cost in human terms of suffering and lost lives is unfathomable.
The staggering burden of cardiovascular disease in the United States, including health care expenditures and lost productivity due to death and disability, was projected to be more than $475 billion in 2009, according to the American Heart Association and the National Heart, Lung, and Blood Institute. In comparison, in 2008 the estimated cost of all types of cancer and benign tumors was USD 228 billion.
The economic burden of cardiovascular disease is no longer a concern only for the wealthy, industrialized world. With the exception of sub-Saharan Africa, CVD is the leading cause of death in developing countries. The economic impact is felt both as a cost to health systems as well as a loss of income and productivity of those directly affected by the disease and caregivers of those with cardiovascular disease, who stop working.
This is exacerbated in developing countries where cardiovascular disease affects a large proportion of working-age adults. In China, direct costs are estimated at more than USD 40 billion or 4% of gross national income. In the Republic of South Africa, 25% of government spending on health care is devoted to cardiovascular diseases. Researchers have already estimated that between the developing economies of Brazil, India, China, South Africa and Mexico, 21 million years of future productive life are lost each year to cardiovascular disease. New studies show obesity has recently overtaken smoking as the “most 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 number of other health problems. An estimated two-thirds of Americans are overweight, of which 50 percent are actually obese. The Mayo Clinic defines obesity as “an excess amount of body fat that is more than just a cosmetic concern.”
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. We have been hearing for years that smoking is the number one cause of various diseases and life-threatening conditions such as lung cancer, emphysema and heart disease; however, recent studies suggest that obesity is beginning to eclipse the risks of smoking and drinking together—and at an alarming rate. In 2008, it was estimated that obesity cost the US $147 billion, and there shouldn’t be much of a delay in 2010. In fact, Thomson Reuters estimates that obese people will spend an average of 40 percent more on health care costs in the coming years — or $1,429 more per year than people in the “normal weight range.” The most pervasive costs of CVD are associated with the incidence of heart failure, which increases with age. In 2000, approximately 12.7 percent of the US population was 65 or older. It is estimated that in 2020 there will be 16.5 percent of them in this age group.
According to the CDC, among US residents who have heart failure, 70 percent are age 60 or older, indicating that the prevalence of heart failure is expected to increase significantly in the coming years. Ironically, another factor that has resulted in an increase in the number of people living with heart failure is the success of treating heart attacks. More effective treatments have resulted in improved survival rates after heart attacks. According to the CDC, more than 20 percent of men will develop heart failure within six years of a heart attack. An even higher percentage (more than 40 percent) of women will suffer from heart failure in the period after the heart attack. Together, the aging population and the improved medical outlook for heart attack victims are responsible for the approximately threefold increase in the annual incidence of heart failure that has been 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 patients with heart failure has improved due to treatment with heart drugs. The human cost Heart failure exacts a cost from patients and their families in terms of additional difficulties patients have in carrying out normal daily activities. This human cost was examined in detail in a recent study by researchers at the University of Michigan Health System and the Veterans Administration Ann Arbor Health System, based on survey responses from 10,626 heart failure patients age 65 and older. The study found that, compared to people without the disease, people with heart failure:
• He is much more likely to be disabled
• They are much more likely to have difficulty with normal daily activities, even things like walking around the room
• More likely to be in nursing homes
• They are more likely to have been in a nursing home in the last two years
• More likely to receive home care
• They are more likely to have experienced clinical conditions that are more common in older adults (such as self-harm due to falls, urinary incontinence and dementia)
The main factor that determines the cost of heart failure treatment is the high frequency of hospitalization. A large percentage of the health care costs associated with heart failure are due to the need for patients to be hospitalized. Patients with heart failure have a high risk of hospitalization. Results from the National Hospital Discharge Survey show that heart failure hospitalizations have increased substantially, from more than 400,000 in 1979 to more than 1.1 million in 2004, accounting for nearly 2 percent of all hospital admissions in the United States.
According to the Centers for Disease Control, among people on Medicare, heart failure is the most common reason for hospitalization. Re-hospitalization rates within six months after discharge are as high as 50 percent. The top three causes of hospitalization for heart failure patients are fluid overload (55 percent), angina (chest pain) or heart attack (25 percent), and irregular heart rhythm (15 percent). Effective treatment of fluid overload is increasingly needed, not only to improve the prognosis of patients with heart failure, but also to improve their quality of life. Repeated hospitalizations are bad for the patient’s prognosis and quality of life, and also cause increased health care costs.
In 2009, in the presentation of Canada’s first comprehensive strategy and action plan for heart health, Dr. Eldon Smith stated that “Cardiovascular disease (heart disease and stroke) is the number one killer and public health threat in Canada, costing the economy more than $22 billion dollars a year.” That represents more than $600 for every man, woman and child without trying to quantify the years lost, the quality of life lost and the love lost.
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