From all indications, we are facing a global pandemic. Cardiovascular diseases (CVD) are the cause of more than 50% of deaths, not only in the developed countries but the World Health Organization (WHO) estimates that low- and middle-income countries are disproportionately affected: 82% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women. The WHO projects that by 2030, almost 23.6 million people will die from CVDs. These are projected to remain the single leading causes of death. The largest percentage increase will occur in the Eastern Mediterranean Region. The largest increase in number of deaths will occur in the South-East Asia Region.
The costs of CVD involve: Direct Costs which include expenditures on hospital care, prescription drugs, physician care, care in other institutions, and additional health expenditures such as for other professionals, capital costs, public health, health research, etc.; plus Indirect Costs – include value of economic output lost because of disability, whether short or long-term, or as a consequence of premature mortality; other costs might include value of time lost from work and/or leisure activities by family members or friends who take care of patients.
CVDs are a group of disorders of the heart and blood vessels including:
• coronary heart disease – disease of the blood vessels supplying the heart muscle
• cerebrovascular disease – disease of the blood vessels supplying the brain
• hypertension – high blood pressure
• peripheral artery disease – disease of the blood vessels supplying 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 impairs its ability to supply sufficient blood flow to meet the body’s needs
• congenital heart disease – malformation of heart structure existing at birth
• deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move 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 build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots.
The burden of CVDs should not be measured by deaths alone. CVD leads to overwhelming economic costs as well as human burdens. CVD cost the EU health care systems just under USD 260 Billion, representing a cost per capita of more than USD 500 per annum, which accounts for 10% of the health care expenditure across the EU. Looking at these direct costs grossly underestimated the true costs of CVD. Production losses from death and illness amounted to USD 55 Billion. The cost of informal care for CVD patients is another major non-health cost estimated at just under USD 60 Billion. This is only the economic costs… the true cost in human terms of suffering and lost lives is incalculable.
The staggering burden of CVD in the United States, including health care expenditures and lost productivity from deaths and disability, was projected to be more than USD 475 Billion in 2009, according to the American Heart Association and the National Heart, Lung and Blood Institute. By comparison, in 2008, the estimated cost of all cancers and benign tumours was USD 228 billion.
The economic load of CVD is no longer of concern only to the affluent, industrialized world. With the exception of sub-Saharan Africa, CVD is the leading cause of death in the developing world. The economic impact is felt both as a cost to health systems as well as loss of income and production of those affected either directly by the disease and caregivers to those with CVD, who stop working.
This is exacerbated in the developing world where CVD affects a high proportion of working-age adults. In China, direct costs are estimated at over USD 40 Billion of 4% of gross national income. In South Africa, 25% of the country’s health care spending is devoted to CVD. Already, researchers have 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 CVD. New studies suggest that obesity recently beat out smoking as the “greatest 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 variety of other health challenges. It’s estimated that two-thirds of Americans are overweight, 50 percent of which are actually obese. Obesity is defined by the Mayo Clinic as having “an excessive 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’s startling is that obesity is gradually becoming a more prevalent risk factor than smoking. For years now, we’ve heard how smoking is the number one 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 eclipse the risks of smoking and drinking combined – and at an alarming rate. In 2008, it was estimated that obesity cost the U.S. $147 billion and 2010 shouldn’t see much of a reprieve. In fact, Thomson Reuters estimates that obese people will spend an average of 40 percent more on health costs – or $1,429 more per year than people within a “normal weight range”, in the coming years. The most pervasive costs of CVD are related to the incidence of heart failure which increases with age. In 2000, approximately 12.7 percent of the American population was 65 years of age or older. It is estimated that in 2020, 16.5 percent will be in this age group.
According to the CDC, among the U.S. residents who have heart failure, 70 percent are 60 years of age or older which indicates a significant increase in the prevalence of heart failure is expected in coming years. Ironically, another factor that has resulted in an increase in the number of people living with heart failure is success in the treatment of heart attacks. More effective treatments have resulted in improved rates of survival following heart attacks. According to the CDC more than 20 percent of men will develop heart failure within six years of having a heart attack. An even higher percentage (more than 40 percent) of women will suffer from heart failure within that period of time after having a heart attack. Together, the aging of the population and an improved medical outlook for heart attack victims account for the approximate threefold increase in the yearly 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 survival of patients with heart failure has improved due to treatment with heart medications. Human Cost Heart failure extracts a cost from patients and their families in terms of the added difficulty patients have in performing normal daily activities. This human cost was examined in depth in a recent study by scientists from the University of Michigan Health System and the Veterans Administration Ann Arbor Healthcare System, based on survey responses from 10,626 heart failure patients 65 years of age and older. The study revealed that, compared to people without the condition, people with heart failure were:
• Much more likely to be disabled
• Much more likely to have difficulties with normal daily activities, even things like walking across the room
• More likely to be in nursing homes
• More likely to have been in a nursing home within the previous two years
• More likely to receive home care
• More likely to have experienced clinical conditions that are more prevalent in older adults (such as hurting oneself because of a fall, urinary incontinence and dementia)
The major factor that determines the cost of treating heart failure is the high incidence of hospitalization. A large percentage of health care costs associated with heart failure are because of the need to hospitalize patients. Patients with heart failure are at high risk for hospitalization. Results of a National Hospital Discharge Survey show that the number of hospitalizations for heart failure has increased substantially, from more than 400,000 in 1979 to more than 1.1 million in 2004, accounting for almost 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 during the six months following discharge are as high as 50 percent. The three main causes of hospitalization in patients with heart failure are fluid overload (55 percent), angina (chest pain) or heart attack (25 percent) and irregular heart rhythms (15 percent). Effective treatment for fluid overload is increasingly needed, not only to improve the prognosis of patients with heart failure but to improve their quality of life. Repeated hospitalizations bode poorly for a patient’s prognosis and quality of life and also cause increased health care costs.
In 2009, Dr. Eldon Smith’s presentation of Canada’s first comprehensive Heart Health Strategy and Action Plan stated “Cardiovascular disease (heart disease and stroke) is Canada’s #1 killer and public health threat, costing the economy more than $22 billion annually.” This represents over $600 for each man, woman and child without attempting to quantify lost years, lost quality of life and lost love.