Acyanotic Heart Disease In Pediatrics Increased Pulmonary Blood Flow Cardiovascular Disease is Killing Us!

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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 disproportionately affected: 82% of CVD deaths. Occurs in low- and middle-income countries and almost equally among men and women. WHO estimates that by 2030, nearly 23.6 million people will die from CVD. It is estimated to remain the only leading cause of death. The Eastern Mediterranean region will see the highest percentage increase. The largest increase in the number of deaths will occur in the South-East Asia region.

Costs of CVD include: direct costs that include hospital care, prescription drugs, physician care, care in other institutions and additional health costs for other professionals, capital costs, public health, health research, etc.; Also indirect costs – include the value of lost economic output due to disability, whether short-term or long-term, or as a result of premature death; Other costs may include the value of time lost from work and/or leisure activities by family members or friends caring for patients.

CVD is a group of cardiovascular 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 Arterial Disease – Disease of the blood vessels supplying the arms and legs

• Rheumatic heart disease – damage to the heart muscle and valves due to rheumatic fever caused by streptococcal bacteria.

• Heart failure – a condition in which a problem in the structure or function of the heart impairs its ability to supply enough blood to meet the body’s needs.

• Congenital heart disease – Abnormalities of the structure of the heart present at birth

• Deep vein thrombosis and pulmonary embolism – blood clots in the veins of the legs, which can break out and travel to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by blockages in blood flow to the heart or brain. The most common cause is fatty deposits on the inner walls of blood vessels that supply the heart or brain. A stroke can also be caused by bleeding from a blood vessel or blood clot in the brain.

The burden of CVD should not be measured solely by mortality. CVD incurs enormous economic costs as well as human burden. The cost to EU health care systems for CVD is under USD 260 billion, representing a cost of more than USD 500 per person per year, which is 10% of health care spending in the EU. Looking at these direct costs underestimates the true costs of CVD. Production losses due to death and disease are estimated at USD 55 billion. Informal care costs for CVD patients are another major non-healthcare cost estimated at just under USD 60 billion. This is just the financial cost… the real cost in terms of human suffering and lives lost is incalculable.

According to the American Heart Association and the National Heart, Lung, and Blood Institute, in 2009 the staggering burden of CVD in the United States, including health care costs and lost productivity due to death and disability, was estimated at more than USD 475 billion. By comparison, in 2008, the estimated cost of all cancers and benign tumors was USD 228 billion.

The economic burden of CVD 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 the developing world. The financial impact is felt both by the cost to the health system as well as by the loss of income and productivity of those directly affected by the disease and the caregivers of 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 expenditure is estimated at more than USD 40 billion, accounting for 4% of gross national income. In South Africa, 25% of the country’s healthcare expenditure is devoted to CVD. Already, researchers estimate that 21 million years of future productive life are lost each year to CVD in the developing economies of Brazil, India, China, South Africa and Mexico. 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 recognized as the number one cause of cardiovascular disease, lung cancer, emphysema and other health challenges. It is estimated that two-thirds of Americans are overweight, 50 percent of whom are actually obese. Obesity is defined by the Mayo Clinic as “an excess of body fat that is more than a mere cosmetic concern.”

According to the Center for Disease Control (CDC), obesity increases the risk of heart disease, diabetes, cancer, high blood pressure (hypertension), stroke, sleep apnea, and osteoarthritis. Shockingly, obesity is slowly becoming a more prevalent risk factor than smoking. For years we have been hearing that smoking is the number one cause of life-threatening conditions such as lung cancer, emphysema and heart disease; However, recent studies suggest that obesity is eclipsing the combined risks of smoking and drinking—and at an alarming rate. In 2008, it was estimated that obesity cost the US $147 billion and that there would be little relief in 2010. In fact, Thomson Reuters estimates that obese people will spend an average of 40 percent more on health care costs — or $1,429 more per year than people in the “normal weight range” in the coming years. The most widespread 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, 70 percent of US residents who have heart failure are 60 years of age or older, with the rate of heart failure expected to increase significantly in the coming years. Ironically, another factor behind the increase in the number of people suffering from heart disease is the success in treating heart disease. More effective treatments have improved survival rates after heart attacks. According to the CDC, more than 20 percent of men develop heart disease within six years of having a heart attack. An even higher percentage (more than 40 percent) of women develop heart disease in the period after a heart attack. Together, the aging of the population and improved medical approaches to heart attack victims account for the approximately threefold increase in the annual incidence of heart attacks observed over the past 10 years.

These factors will also increase the economic impact of heart disease. This is true even though the survival rate of heart disease patients has improved due to treatment with heart disease drugs. Human costs Heart failure imposes costs on patients and their families in terms of additional difficulty for patients to perform normal daily activities. A recent study by scientists at the University of Michigan Health System and the Veterans Administration Ann Arbor Healthcare System took a closer look at this human cost based on survey responses from 10,626 heart disease patients age 65 and older. Studies have shown that, compared to people without the condition, people with heart failure had:

• More likely to be disabled

• Difficulties are more likely to occur with normal daily activities, even things like walking across a room

• More likely to be in a nursing home

• More likely to have been in a nursing home in the past two years

• More likely to receive home care

• Older adults are more likely to experience clinical conditions that are more prevalent (such as self-injury due to falls, urinary incontinence, and dementia).

A major factor determining the cost of heart failure treatment is the high incidence of hospitalization. A large percentage of health care costs associated with heart failure are the need for hospitalization. Patients with heart failure are at higher risk of hospitalization. Results from the National Hospital Discharge Survey show that the number of hospitalizations for heart failure has increased significantly, 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, heart failure is the most common cause of hospitalization among people on Medicare. The rate of re-hospitalization within six months of discharge is 50 percent. The three leading causes of hospitalization in heart failure patients are fluid overload (55 percent), angina (chest pain) or heart attack (25 percent), and irregular heart rhythm (15 percent). Effective treatments for fluid overload are needed not only to improve the prognosis of heart disease patients but also to improve their quality of life. Frequent hospitalizations have a worse impact on the patient’s prognosis and quality of life and increase health care costs.

In 2009, Dr. Alden Smith, in his presentation of Canada’s first comprehensive Heart Health Strategy and Action Plan, states that “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 more than $600 for every man, woman and child without even trying to calculate the lost years, lost quality of life and lost love.

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