The combined direct and indirect costs of cardiovascular disease in the US in 2010 will be half a trillion dollars, according to the AHA, which has just released its Heart Disease and Stroke Statistics – 2010 Update.
Here are some other key statistics:
In 2006 the overall death rate from CVD was 262.5 per 100 000:
- white males: 306.6 per 100 000
- black males: 422.8 per 100 000
- white females: 215.5 per 100 000
- black females: 298.2 per 100 000
CVD deaths declines from 1996 to 2006 by 29.2%, but in 2006 still accounted for more than one-third (34.3%) of all deaths in the United States (831,272 out of 2,426,264).
One-third (33.6%) of US adults 20 years of age or older have hypertension. The hypertension rate in African-American adults is 43%, which the AHA calls among the highest in the world.
16.2% of US adults (35,700,000) have total cholesterol levels greater than 240 mg/dl.
7.7% of US adults have diagnosed diabetes. 6.1 million have undiagnosed diabetes, and 29% have prediabetes.
Two-thirds of US adults (144,100,000) are overweight or obese; 32.9% are obese.
- 31.9% of children 2-19 years of age are overweight or obese; 16.3% are obese.
Between 1996 and 2006 inpatient CV operations and procedures increased by 33%, from 5,444,000 to 7,235,000 each year. Total hospital costs in 2010 will approximate $155.7 billion
Dr. Richard Fogoros (who writes about heart disease for About.Com and has another blog as well as the Covert Rationing Blog)sent the following comment to CardioBrief:
I have no basis for quibbling with the numbers provided here by the AHA. Americans are getting fatter and becoming more sedentary, and undoubtedly that’s contributing to an increase in the incidence of cardiovascular disease.
I will simply point out that, as we embark on the brave new world of preventive medicine promised by our impending healthcare reforms, we are going to have to decide which of two competing goals we want to accomplish by means of preventive medicine: a) preventing disease, or b) reducing the cost of healthcare. All too often (for instance, in this AHA press release) we tend to confuse those two goals.
It is trivial to note that whether preventive medicine will actually reduce the cost of healthcare depends on at least four variables. These include 1) the cost of the preventive measure (e.g., a screening test or a therapy); 2) how effective the preventive measure is in actually preventing the target condition; 3) the cost of the target condition, should it occur, and d) the extra cost of healthcare the patient (who often has chronic underlying medical conditions) will consume as a result of successfully avoiding the target condition. There are other variables that might be considered as well, but these four get the point across.
So, for instance, the AHA press release implies that if everyone indicated for statin therapy actually took statins, the overall cost of healthcare would be reduced. This may or may not be true, but it is worth noting that if all 11 million middle-aged adult Americans who just this week became indicated for rosuvastatin actually took it, the cost to the healthcare system would be about $20 billion annually (11 million patients consuming $1800 of rosuvastatin per year). It is not obvious, to me at least, when taking all four variables into account (including the fact that 20 – 30% of the “events” that we would be preventing would likely be sudden death, which is “free” to the healthcare system), that we would save any money. All we might be doing is preventing disease.
And while that may seem like a fine goal, it is no longer THE goal of preventive medicine. The real purpose of preventive medicine, our political leaders now assure us, has been officially changed to: saving money. To achieve that goal, we may find it necessary, using a myriad of techniques at the disposal of the insurance companies and the feds, to “discourage” clinicians from, say, prescribing rosuvastatin to the 11 million folks at increased risk but with “normal” LDL levels.
If the people writing press releases for the AHA and similar organizations continue conflating these two very different and often competing goals for preventive medicine, simple country electrophysiologists like myself will continue finding it difficult to know what to make of it all.
Here is the AHA press release:
Statistics highlights:
- The estimated direct and indirect cost of cardiovascular disease for 2010 is $503.2 billion according to the American Heart Association’s Heart Disease and Stroke Statistics – 2010 Update.
- The proportion of adolescents having no regular physical activity is high, and the proportion increases with age.
- Fewer than half of even the highest-risk persons – those with symptomatic coronary heart disease (CHD) – are receiving lipid-lowering treatment, and only about one-third of treated patients are achieving their low-density lipoprotein (LDL – “bad cholesterol”) goal; fewer than 20 percent of CHD patientsare at their LDL goal.
American Heart Association year-end report:
Healthcare costs rise as risk factors remain widespread
DALLAS, Dec. 17 – The prevalence and control of heart disease risk factors and the rising cost of treating heart disease remains an issue for many Americans, according to the latest data in the American Heart Association’s Heart Disease and Stroke Statistics – 2010 Update, published online in Circulation: Journal of the American Heart Association.
Some experts believe the lack of risk factor control may be fueling increased healthcare costs associated with treating cardiovascular disease and stroke.
“Undoubtedly some of these rising costs are due to adverse trends in risk factors, particularly related to the obesity epidemic,” said Donald M. Lloyd-Jones, M.D., chair of the American Heart Association Statistics Committee.
“We already have data to suggest that the decade-long decline in coronary death rates is flattening or reversing in younger adults, likely due to the fact that they have lived their lives with a significant burden of obesity.”
Lloyd-Jones is chairman of the department of preventive medicine and staff cardiologist at the Northwestern University Feinberg School of Medicine in Chicago.
According to the Update, projected estimated costs for cardiovascular disease (CVD) and stroke treatments in the United States will reach $503.2 billion in 2010 which is a 5.8 percent increase over the previous year.
The CVD and stroke figure includes both direct and indirect costs. Direct costs include the cost of physicians and other professionals; hospital and nursing home services; prescribed medications; home health care;and other medical durables. Indirect costs include lost productivity resulting from death and disease.
From 1996 to 2006, the total number of inpatient cardiovascular operations and procedures increased 33 percent, from 5,444,000 to 7,235,000, according to the Update.
The association’s goal is, by 2020, to help improve the cardiovascular health of all Americans by 20 percent while also reducing deaths from cardiovascular diseases and stroke by 20 percent.
“To reach the 2020 goals, Americans must start making healthier lifestyle choices,” said Lloyd-Jones. “Current statistical data show Americans to be on average overweight, physically inactive and eating a diet that is too high in calories, sodium, fat and sugar. Also, too many people are not compliant with taking prescribed cholesterol-lowering medicines that could lower their risk. One reason it will cost us more to treat tomorrow’s patients is because there will be more of them if current trends continue.”
Some statistics on risk factors from the 2010 Update:
- Physical inactivity: 59 percent of adults who responded to a 2008 national survey reported engaging in no vigorous activity (activity that causes heavy sweating and a large increase in breathing or heart rate).
- Cholesterol:Fewer than half of even the highest-risk persons (those with symptomatic coronary heart disease) are receiving lipid-lowering treatment, and only about one-third of treated patients are achieving their goal blood level of low-density lipoprotein (LDL – the “bad” cholesterol). Fewer than 20 percent of coronary heart disease patients are at their LDL goal.
- Obesity:Nearly 10 million children and adolescents 6 to 19 years of age have body mass index (BMI)-for-age values at or above the 95th percentile of the 2000 Centers for Disease Control (CDC) growth charts for the United States.
- – Data from 2003–06 show that 11.3 percent of children and adolescents 2 to 19 years of age were at or above the 97th percentile of the 2000 BMI-for-age growth chart, 16.3 percent were at or above the 95th percentile, and 31.9 percent were at or above the 85th percentile
- –Overweight adolescents have a 70 percent chance of becoming overweight adults. This increases to 80 percent if one or both parents are overweightor obese.
- Inpatient cardiovascular operations and procedures: In 2006, an estimated 7.2 million were performed in the United States; 4.1 million on men and 3.1 million on women.
- Cost:In 2006, $32.7 billion in program payments were made to Medicare beneficiaries discharged from short-stay hospitals who had a principal diagnosis of cardiovascular disease – an average of $10,201 per discharge.
An analysis of dietary, lifestyle and metabolic risk factors shows that targeting a handful of factors – waist size, blood sugar levels, low high-density lipoprotein (HDL, the “good” cholesterol) and triglycerides – has large potential to reduce death rates in the U.S. These are risk factors included in the condition known as metabolic syndrome, which is associated with type 2 diabetes and cardiovascular disease.
“While many people may need medication to manage these risk factors, lifestyle interventions are effective and important, and can even reduce the need for medications,” Lloyd-Jones said.
As reported previously, death rates from cardiovascular disease declined about 30 percent between 1996 and 2006. Also, quality-of-care data show that patients are now more likely to receive guideline-centered care during a hospital stay related to heart disease.
“This information shows that we’re getting very good at handling an acute event in this country,” said Lloyd-Jones. “However, the risk factor data we’re seeing now indicate a larger future burden on the healthcare system unless these trends turn around. On the flip side, risk factor management and maintaining health through prevention is infinitely cheaper than disease management and treating illness.”
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