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What is the cost of heart failure?

Heart Health Pictures According to the American Heart Association, in 2008 the estimated total cost of heart failure in the United States will be more than $35 billion. See more pictures of heart health.
©iStockphoto/Tpopova

Heart failure occurs when the heart becomes weakened following a heart attack or from the long-term effects of high blood pressure. The weakened heart muscle becomes unable to maintain adequate blood flow to the body's tissues and organs. Heart failure is serious, and it's a major cause of death. Treatment is available for heart failure, but it can't be cured. After a patient receives a diagnosis of heart failure, he or she will need lifelong treatment for the condition.

The worldwide statistics for people with heart disease and heart failure are sobering. In industrialized countries, the prevalence of heart failure is 1 to 2 percent of the general population, and treating heart failure consumes 1 to 2 percent of the total health care resources, a proportion that is expected to increase in the future.

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The American Heart Association estimates that about 5 million people nationwide have heart failure, and its prevalence is growing. They also estimate that cardiovascular diseases (heart and blood vessel diseases) cause almost twice as many deaths in the United States as cancer of all types combined. According to the National Institutes of Health, 550,000 new cases of heart failure are diagnosed and 300,000 deaths are caused by heart failure each year.

Heart failure puts very significant health and financial burdens on patients, their families and society as a whole. According to the American Heart Association, in 2008 the estimated total cost of heart failure in the United States will be more than $35 billion.

On the next page, we'll learn about the increased incidence of heart failure and why it might be happening.

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The incidence of heart failure increases with age. According to the Centers for Disease Control, among the U.S. residents who have heart failure, 70 percent are 60 years of age or older. 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. Since the American Heart Association estimates that about 1 percent of all people over the age of 65 has heart failure, 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 Centers for Disease Control, 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.

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Together, the aging of the U.S. 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.

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 (accounting for approximately 800,000 hospitalizations yearly). The average hospital stay for heart failure is about six days. Rehospitalization rates during the six months following discharge are as high as 50 percent.

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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.

For more information about heart failure and related conditions, take a look at the links on the next page. 

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More Great Links

Sources

  • Bart B, Boyle A, Bank AJ, et al. The RAPID Study: Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure. J Am Coll Cardiol. 2005;46:2043-2046.
  • Bart BA, Boyle A, Bank AJ, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure. J Am Coll Cardiol. 2005; 46:2043-2046.
  • Bourge RC, Tallaj JA. Ultrafiltration: a new approach toward mechanical diuresis in heart failure. J Am Coll Cardiol. 2005; 46:2052-2053.
  • Bundkirchen A, Schwinger RHG. Epidemiology and economic burden of chronic heart failure. Eur Heart J Suppl. 2004;6:D57-D60.
  • Burns RB, McCarthy EP, Moskowitz MA, et al. Outcomes for older men and women with congestive heart failure. J Am Geriatr Soc. 1997;45:276-280.
  • Cleland JG, Swedberg K, Follath F, et al. The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J. 2003;24:442-463.
  • Costanzo MR, Guglin ME, Saltzberg MT, et al. The UNLOAD Study: Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007; 49:675-683. www.unloadstudy.com
  • Costanzo MR, Saltzberg M, O'Sullivan J, et al. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol. 2005; 46:2047-2051.
  • Costanzo MR, Saltzberg M, O'Sullivan J, et al. The EUPHORIA Study: Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol. 2005;46:2047-2051.
  • Elkayam U, Hatamizadeh P, Janmohamed M. The challenge of correcting volume overload in hospitalized patients with decompensated heart failure. J Am Coll Cardiol. 2007;49:684-686.
  • Gure TR, Kabeto MU, Blaum CS, et al. Degree of disability and patterns of caregiving among older Americans with congestive heart failure. J Gen Intern Med. 2008;23:70-76.

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