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Cardiovascular Disease and its Economic and Emotional Impact in America

Posted Apr 06 2011 5:53pm
          Cardiovascular Disease, or CVD, is a general term used to describe any of the sixty or more diseases which can affect the heart and vascular systems. Many of these diseases can lead to an increase in the incidence of heart attack, heart failure, stroke and death . As of 2008, more than eight million Americans were living with some form of CVD which leads one to wonder, how many people are living with CVD and do not even know it?   With knowledge is power, and the more Americans know and understand about this disease, the better able they will be to prevent and treat it. By educating the public, America may be able to lower the financial and emotional burdens of this disease (American Heart Association).Unfortunately, CVD is the leading cause of death in America. Statistics show that one of every three people over the age of 20 will die from some form of CVD. In the past 110 years (except in 1918), CVD has killed more people than cancer, AIDS, COPD (including chronic bronchitis and emphysema), accidents and diabetes mellitus combined.   Many people look at this disease and its high price tag (Americans spent about $172 billion dollars in 2010 alone, and are expected to spend over $818 billion between 2010 and 2030), and are astonished by the costs. What many people do not realize is that not only does CVD cost Americans a ridiculous amount of money each year, but the costs that are incurred by the poor quality and quantity of life that the people and families who live with it, may be even more costly to us (American Heart Association).When there is a malfunction in any of the parts of the heart or the blood vessels, this is known as CVD. Unfortunately, there are over 60 different diseases that are considered CVD. Some may be very serious such as Tetrology of Fallot, and some may just be a nuisance such as varicose veins. Despite the varying degrees of severity, it is known that certain diseases occur more frequently than others and thus tally up the most financial burden. The diseases that occur most often are:coronary artery disease (CAD), atherosclerosis, angina, heart failure, stroke, hyperlipidemia (high cholesterol) and hypertension (high blood pressure).Coronary artery disease (CAD) affects people of all ages. According the American Heart Association, one out of every three children (aged 2-18) has abnormal blood cholesterol levels (a marker of CAD). High levels of unhealthy cholesterol circulating in a person’s blood can lead to a buildup of fatty acids on the inside of the blood vessels. These buildups, called plaque, continue to grow and over time they narrow the inside of a blood vessel and restrict the flow of blood to the parts of the body. When this happens, the disease process has now progressed from hyperlipidemia (high blood cholesterol levels) to atherosclerosis (hardening and narrowing of the blood vessels). The location of plaque is in a person’s body, can determine what types of disease and symptoms they might have. Without adequate nutrients and oxygen, the organs of the body are not able to function properly and if blood flow is not restored, the organs can suffer permanent damage or even failure (The Texas Heart Institute).Angina is the temporary blockage of blood flow to the heart. Without proper blood flow the heart is not able to continue to circulate blood to the rest of the body. There are a few different types of angina, but all should go away with rest. If pain does not go away with rest, the person may be suffering a permanent blockage of the arteries in the heart, which is more commonly referred to as a heart attack. Every year more than 785,000 Americans suffer from their first heart attack and another 470,000 people who have already had a heart attack have another one (American Heart Association).When heart tissue is damaged, it can be repaired over time with exercise and care, but if a person has damaged too much tissue, it can lead to heart failure. A person can also suffer from congestive heart failure over time, just from advanced age. The heart, just like every other muscle can atrophy over time. If the heart muscle is tired, or unable to pump efficiently, it is known as heart failure. People with heart failure may find that they are fatigued, short of breath or have swelling in their bodies. This is because the blood that should be getting pumped through the heart is backing up because the heart cannot contract as forcefully. Depending on which chamber of the heart is the sickest, the blood could back up into the lungs (causing shortness of breath) or into the Vena Cava (causing swelling in the body because the blood coming back to the heart is slowed.)A stroke (or brain attack), is another possible complication of atherosclerosis. If the arteries that supply the brain with blood are blocked, or if part of the plaque deposit breaks off and gets lodged in the brain, a person will have the symptoms of a stroke. Because our brain is so complex, people who are having a stroke may have some abnormal symptoms. Without blood flow to the brain, it is unable to work properly; people who have had a stroke may be confused, they may not be able to walk or talk, or they may have a terrible headache. Whatever the symptoms, it is extremely important that the person be treated by emergency personnel as soon as possible. Each year about “795,000 people have a stroke,” and the mean lifetime costs to care for a person who has suffered an ischemic stroke is estimated at $140,048 (AHA).   This cost includes rehabilitation, inpatient care and follow-up care for lasting deficits. Stroke survivors are one of the leading causes of “serious, long-term disability in the United States” (NHLBI). Overall, the estimated direct and indirect cost of stroke for 2009 was $68.9 billion dollars.Another common CVD is hypertension (HTN). Hypertension complicates all of the previous diseases by making the blood vessels less pliable and adaptive. According to the National Heart, Lung and Blood Institute’s Framingham Heart Study, people with high blood pressure have a “shorter overall life expectancy as well as a shorter life expectancy free of CVD and more years lived with CVD.” Considering that one-third of all Americans have high blood pressure (hypertension) and one-fourth of Americans over the age of twenty are “pre-hypertensive,” the Framingham study can be quite frightening for most. Other data from the NHLBI’s Framingham study shows that only 45% of people who are diagnosed with hypertension have it well-controlled. This is discouraging considering that about 70% of people who have their first heart attack, 77% of people who have their first stroke and 74% of people who suffer with congestive heart failure have a blood pressure reading of 140/90 mmHg or higher. Even more frightening is that uncontrolled hypertension directly leads to a slew of other high-cost medical problems such as blindness, end-stage renal disease (ESRD), impotence and neuropathies.There are many other forms of CVD that are not quite as common as the previously named ones. Some of these include:arrhythmias, cardiomyopathies, congenital heart diseases, heart valve diseases, inflammatory diseases, and vessel problems. Although these diseases are not as common in the American public, they are every bit as serious. Some of these diseases can affect our babies and children (congenital heart diseases), and some can be caused by old age or wear and tear (cardiomyopathies.) Many people may not even know that they have an arrhythmia or a valve disease and live their entire lives never having any problems from their form of CVD.Symptoms of heart disease can range from fatigue to sudden death. For this reason it is important for all people to follow their doctor’s advice for regular check-ups. All people are unique and so are their symptoms. For example, men experience heart attack pain differently than women. Men typically have chest, jaw or back pain or pressure, shortness of breath, and weakness. Women may experience symptoms as subtle as fatigue and indigestion. Because symptoms can vary so greatly, it is important to know one’s family history and other possible risk factors.Unfortunately, some risk factors are unavoidable. Things such as family history, age, gender, race and certain diseases like high cholesterol, high blood pressure and diabetes cannot be changed. Numerous studies conducted by the Centers for Disease Control and Prevention, the American Heart Association and the National Heart, Lung and Blood Institute (a division of the National Institute of Health) have found that people over 50 are more likely to suffer a cardiac event as opposed to a younger person; men are more likely than women to suffer a cardiac event under the age of 50; African-Americans are more likely to have a cardiac event than Caucasians and people with high blood pressure, high blood cholesterol and diabetes are more likely to have a cardiac event than people who do not. These numbers may seem hopeless for many who have multiple non-modifiable risk factors, but luckily research has shown that there are many things we can do (most of which are low-cost and unobtrusive) to lower the risk of becoming yet another American living with this disease.The single most-effective thing a person can do to reduce their risk of CVD is to quit smoking. According to the American Heart Association, “Cigarette smoking is the most important preventable cause of premature death in the United States. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot.” Fortunately, with the costs of cigarettes skyrocketing, many current smokers are able to see through the smoke and realize the need for change. According to the website, tobaccofreekids.org, the total annual American health care expenditures caused by smoking is $96 billion dollars. In addition to that, they estimate that productive losses caused by smoking to be near $97 billion.Another effective way to reduce the risk of CVD is to maintain a healthy weight for a person’s height. The AHA recommends that Americans maintain a healthy BMI and that men monitor their waistline and stay below 40 inches, and that women have a waistline no larger than 35 inches. Currently, however, America is in an obesity epidemic. According to the Weight-control Information Network, more than one-third of American adults are obese. With obesity, there seems to be a vast array of high-cost comorbidities that plague the overweight: Diabetes, Depression, GERD and multiple others, especially CVD.   Obese people spend about “$1,500 more each year on health care, about 41% more than an average weight person.” (Weight-control Information Network)   Despite the hype on television and in magazines, there is no quick fix to obesity. There are only two proven methods to help an overweight person obtain a healthy weight: diet and exercise.A heart-healthy diet promotes low-fat, whole grains, reduced-sodium and lots of vegetables and fruits. A person can simultaneously reduce their weight and risk of CVD by decreasing their daily amount of calories, and restricting animal-fats, full-fat dairy and sweets while filling up on vitamin and nutrient-rich whole grains, non-animal proteins and heart-healthy fats such as almonds, avocados and olive oil. In addition to eating a healthy diet, it is also important to reduce or modify the amounts of alcohol one drinks. Studies have shown that one serving of alcohol per day for women, and two for men, is considered a safe amount and may also have some heart-healthy benefits such as reducing the incidence of clotting and vessel spasms (American Heart Association).In addition to a heart-healthy diet, a person can increase their amount of physical activity to additionally reduce their weight and risk for CVD. The AHA recommends 30 minutes of exercise per day, three to five times per week. Studies have found that regular exercise can strengthen the heart muscle, lower bad cholesterol, increase good cholesterol and lower the blood pressure. Other benefits of exercise include less stress, anxiety and depression, all mental health concerns that can lead to undue stress on the heart.Fortunately, today’s Americans are lucky enough be alive during an era where modern medicine has advanced to the point that it is able to assist people   with monitoring, preventing and treating these diseases.Based on a family history or personal risk assessment, today’s patients are able to follow up with their providers for further testing if they feel they may be at risk for heart disease. There are multiple diagnostic exams that allow a better view of the patient’s heart and its functioning.   Tests such as electrocardiograms, echocardiograms, stress tests, CT scans and angiograms provide doctors just as much, if not more information that cutting open the person’s chest and examining their heart by hand.Although CVD can be very scary and lead to bad things, proper treatment can allow those with CVD to live long and relatively healthy lives. In addition to following the AHA’s guidelines for smoking cessation, heart-healthy diet, regular exercise, alcohol moderation and stress relief, doctors and other practitioners have the ability to prescribe helpful medications that can reduce blood pressure, cholesterol or the workload of the heart. Of course, if the holistic methods of treatment or pharmaceuticals do not treat the disorder properly, there are many skilled physicians who can perform invasive procedures to alleviate or lessen the disease.Often times, when a person comes to the emergency room, complaining of chest pain, the less invasive treatments are used at first. Doctors or nurses take a history from the patient, they access for risk factors, the person’s individual symptoms are considered, blood work is drawn, medicine is given, oxygen is administered, diagnostic testing is ran. Depending on the results of these tests, doctors may feel it is necessary to perform more invasive tests and treatments.One procedure that is performed often is an angioplasty, where they insert a long, thin catheter that has a deflated balloon on the end. Using X-rays, the doctor is able to locate the blockage and expand the balloon to compress the plaque so the blood is able to flow freely again. Often times, doctors who perform this procedure will insert a stent at the same time. A stent is a tiny mesh-like tube that keeps the vessel walls open after the angioplasty (Texas Heart Institute). According to the website, healthcarebluebook.com, the average national cost for a typical coronary angioplasty at the hospital is $22,020 and it is estimated that in 2006, 1,313,000 angioplasties were performed (AHA).Occasionally, after an angioplasty, people will continue to have problems with clotting or growth of scar tissue at the point of the stent. One thing that doctors have found that prevents the growth of tissue is radiation. The doctor can perform this procedure during the angioplasty or cardiac catheterization procedure if he or she feels that there is cause for it. The doctor uses a catheter, similar to the balloon catheter that is designed to apply radiation to a very small localized area. Some people who have conductivity problems in their heart’s electrical system will also have this procedure to help “kill off” the area that is causing the heart to not beat the right way.Other times, a physician may not be able to treat the blockage with angioplasty. If this is the case, the doctor may need to perform a very common type of open-heart surgery in the United States called coronary artery bypass surgery, or CABG. During this procedure, the doctor “re-routes” or grafts arteries or veins from other parts of the body to bypass the blocked heart arteries and allow blood to supply the heart with the proper oxygen and nutrients. This procedure is very invasive and requires a long hospitalization, the estimated, fair price costs for this procedure amount to $61,800 per patient. This price does not reflect the cost related to CABG such as multiple medications, frequent follow ups, home health care and often cardiac rehab.If a person has problems with arrhythmias, or the rate or rhythm of their heart, they may be a good candidate for a pacemaker. A pacemaker is a small device that is placed under the skin of the chest that reads and regulates the cardiac pace. The pacemaker has leads that the doctor implants into the heart that continuously monitor the patient’s heartbeat. If something goes awry, like the heart speeds up or skips a beat, the pacemaker will send a small electrical pulse to the SA node and it tells the heart to “start over.” Usually, this small pulse is enough to correct any arrhythmias; however, some people have very serious arrhythmias that can cause sudden cardiac arrest and death. These people, if they are good candidates, can have a pacemaker with defibrillator implanted into them. The procedure is the same as the pacemaker, except the machine that is implanted is made to recognize a fatal arrhythmia and “shock” the heart back to rhythm. This machine is the equivalent to a person having the “paddles” shock them back to life (however the voltage is much lower since the leads are placed directly on the heart tissue.) In 2006, there were over 522,000 surgically implanted pacemakers and defibrillators were placed into patients with deadly arrhythmias. The fair price as estimated by healthcarebluebook.com for this procedure is $21,668.            One final solution for some people with serious injury or disease in their heart is a heart transplant. A person must be very sick to qualify for such a risky treatment. Obviously, there are drawbacks to this method of treatment. A person who received any type of implant must be monitored very closely for years and many times they must take medication for the rest of their lives to insure that their body’s own immune system does not attack the “foreign” body. Also, the availability of donor hearts is not nearly as close to the demand as hoped for. The surgery is very risky for the patient. Because many of the patients who require a heart transplant are very sick, many of them are not physically strong enough to survive such a serious surgery. Despite the risks, there is an average of about 2,000 heart transplants performed each year in the United States (National Organ Procurement and Transplant Network).            So although many of these diseases may not be preventable, with proper treatments, Americans can live long, happy lives with CVD. The overall economic impact of this disease is baffling. Although the direct costs of CVD calculate to about $168 billion, the total direct and indirect costs of CVD in 2008 were estimated at $475.3 billion. This number includes the health expenditures for the hospitals, physicians, medications and other services like home health care and durable medical equipment but also calculates the indirect costs of lost productivity from morbidity and mortality.            The purpose of learning about CVD, the risk factors, symptoms, treatments and costs is not to make one feel depressed or hopeless, but to help empower the person at risk or who is already living with CVD to make healthy decisions and seek support from their providers and other resources.  Works Cited

American Heart Association.11 Feb 2011 http://www.americanheart.org

Centers for Disease Control and Prevention.11 Feb 2011 http://www.cdc.gov

Healthcare Blue Book.11 Feb 2011 http://www.healthcarebluebook.com

National Heart, Lung and Blood Institute at the National Institute of Health.11 Feb 2011 http://www.nhlbi.nih.gov/

National Organ Procurement and Transplant Network.11 Feb 2011  http://optn.transplant.hrsa.gov/data/

The Texas Heart Institute at St. Lukes Episcopal Hospital.11 Feb 2011 http://www.texasheartinstitute.org

The Weight-control Information Network.11 Feb 2011 http://www.win.niddk.nih.gov/statistics/index.htm

Tobacco Free Kids.11 Feb 2011 http://www.tobaccofreekids.org                                                                                   

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