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Cardiovascular Disease is Killing Us!
From 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 significantly affected disproportionate: 82% of CVD deaths occur. in low- and middle-income countries and occur almost equally in men and women. WHO predicts that by 2030, almost 23.6 million people will die from cardiovascular diseases. These are expected to be the main causes of death. The largest percentage increase will occur in the Eastern Mediterranean region. The largest increase in the death toll will occur in the Southeast Asian region.
The costs of CVD involve: Direct costs that include expenses for hospital care, prescription drugs, medical care, care in other institutions and additional health 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, 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 by family members or friends caring for patients.
CVD is a group of heart and blood vessel disorders that include:
• coronary 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 impairs its ability to supply enough blood flow to meet the body’s needs.
• congenital heart disease – malformation of the cardiac structure existing at birth
• deep vein thrombosis and pulmonary embolism: blood clots in the veins of the legs, which can dislodge 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 the 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 by blood clots.
The burden of CVD should not be measured by deaths alone. CVD carries overwhelming economic costs and human burdens. CVD cost EU healthcare systems just under USD 260 billion, representing a per capita cost of over USD 500 per year, representing 10% of healthcare spending across the EU. By looking at these direct costs, the true costs of CVD have been greatly underestimated. Production losses due to death and disease amounted to 55 billion dollars. The cost of informal care for CVD patients is another major non-healthcare cost estimated at just under $60 billion. These are just the economic costs…the real cost in human terms of suffering and lives lost 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 healthcare costs and lost productivity from death and disability, is projected to exceed 475 billion of dollars in 2009. In comparison, in 2008, the estimated cost of all cancers and benign tumors was $228 billion.
The economic burden of CVD is no longer of interest 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 the health systems and the loss of income and production of those affected either directly by the disease and by carers to people 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 more than $40 billion, 4% of gross national income. In South Africa, 25% of the country’s health expenditure is devoted to CVD. 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 CVD. New studies suggest obesity has recently overtaken smoking as the ‘biggest 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 variety of other health problems. An estimated two-thirds of Americans are overweight, 50% of whom are obese. The Mayo Clinic defines obesity as having “an excessive amount of body fat that is more than an aesthetic 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. For years, we’ve been hearing how smoking is the number one cause of a variety of life-threatening diseases and conditions, including 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, obesity was estimated to cost the US $147 billion, and 2010 should not be seen in isolation. In fact, Thomson Reuters estimates that obese people will spend an average of 40 percent more on health care costs, or $1,429 more annually than people within a “normal weight range,” in the coming years. The most widespread costs of CVD are related to the incidence of heart failure that increases with age. In 2000, approximately 12.7% of the US population was 65 years of age or older. It is estimated that by 2020, 16.5 percent will be in this age group.
According to the CDC, among U.S. residents who have heart failure, 70 percent are age 60 or older, indicating that a significant increase in the prevalence of heart failure is expected in the coming years. Ironically, another factor that has led to an increase in the number of people living with heart failure is the success in treating heart attacks. More effective treatments have resulted in improved survival rates 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. An even higher percentage (more than 40%) of women will experience heart failure during this time period after having a heart attack. Together, an aging population and an improved medical outlook for heart attack victims account for the roughly threefold increase in the annual incidence of heart failure seen 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. Human cost Heart failure exacts a cost on patients and their families in terms of the added difficulty patients have in carrying out normal daily activities. This human cost was examined in depth in a recent study by scientists at the University of Michigan Health System and the Veterans Administration’s Ann Arbor Health System, based on survey responses from 10,626 patients with heart failure. heart of 65 years or older. The study revealed that, compared to people without the disease, people with heart failure were:
• Much more likely to be disabled
• You are much more likely to have difficulty 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 in the previous two years
• More likely to receive home care
• More likely to have experienced clinical conditions that are more common in older adults (such as falling, urinary incontinence, and dementia)
The main factor that determines the cost of heart failure treatment is the high incidence of hospitalization. A large percentage of the healthcare costs associated with heart failure are due to the need to hospitalize patients. Patients with heart failure have a high risk of hospitalization. Results from 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 nearly 2 percent of all hospital admissions in the United States.
According to the Centers for Disease Control, among people with Medicare, heart failure is the most common reason for hospitalization. Rehospitalization rates within six months of discharge are as high as 50 percent. The three leading causes of hospitalization in heart failure patients are fluid overload (55%), angina pectoris (chest pain) or heart attack (25%), and irregular heart rhythms (15 %). An effective treatment for 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 bode poorly for a patient’s prognosis and quality of life and also lead to increased healthcare costs.
In 2009, the presentation of Dr. Eldon Smith of Canada’s first comprehensive heart health strategy and action plan stated that “cardiovascular disease (heart disease and stroke) is Canada’s No. 1 killer and public health threat, costing the economy more than $22 billion annually.” That’s over $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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