WASHINGTON – Approximately 40% of the United States population could have some form of cardiovascular disease by the year 2030, based on data from a prediction model created by the American Heart Association. The findings were published online on Jan. 24 in an American Heart Association policy statement in Circulation.
If there’s a silver lining in these figures, it is that they are projections," Nancy Brown, chief executive officer of the AHA, said at a press conference. However, if current policies and prevention strategies go unchanged, the United States is facing "a cardiovascular crisis of alarming proportions," she said.
The aging U.S. population and the increase in medical spending are the main forces driving the disease prevalence and cost, wrote Dr. Paul Heidenreich, of the VA Palo Alto (Calif.) Health Care System, and colleagues.
Without changes in current prevention and treatment trends, the prevalence of cardiovascular disease in the United States will increase by about 10% over the next 20 years, and direct medical costs of cardiovascular disease will triple, from $273 billion to $818 billion, according to the policy statement.
The AHA statement projects an additional 27 million Americans with hypertension, 8 million with coronary heart disease, 4 million with stroke, and 3 million with heart failure between 2010 and 2030 (Circulation 2011 Jan. 24 [Epub doi: 10.1161/CIR.0b013e31820a55f5]).
According to the projections, hypertension will be the most expensive component of cardiovascular disease (CVD), with an estimated annual direct medical cost of $200 billion by 2030. The estimated direct medical cost for stroke is $96 billion, compared with $28 billion in 2010, but stroke represents the greatest relative increase in costs over the next 20 years (238%).
In addition, the indirect costs of all types of cardiovascular disease could increase by 61% (from $172 billion in 2010 to $276 billion in 2030).
However, previous studies have shown that many CVD cases are preventable, and individuals who maintain a healthy lifestyle and favorable levels of atherosclerotic risk are less likely to develop CVD. "Therefore, a greater focus on prevention may alter these CVD projections in the future," according to the statement.
Guidelines have been shown to have "a substantial impact on prevention and treatment and will be an important tool for limiting the burden of CVD," according to the statement. The AHA, the American College of Cardiology, and other organizations have previously published prevention-oriented CVD guidelines, but the implementation of such guidelines is often slow, the writing group noted.
Other factors that could hamper the improvement of CVD risk factors include a reported shortage of cardiologists, they added. Other shortages exist in nursing, pharmacy, and primary care, all of which are needed for a team approach to preventing CVD.
The take-home message for cardiologists is that they can "expect to see more demand for their services," Dr. Heidenreich said in an interview. In addition, primary care physicians will be seeing more patients with forms of heart disease. But the solution includes increasing the number of health professionals across all fields, not only cardiology, said Dr. Heidenreich. "The whole medical complex is insufficient to meet the demand" of the potential increases in CVD, he emphasized.
But, "through a combination of improved prevention of risk factors, and treatment of established risk factors, the dire projection of the health and economic impact of CVD can be diminished," the statement concluded.
The projections of CVD prevalence were based on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006 and Census Bureau projections from 2010 to 2030. Projections of direct medical costs of CVD were based on data from the Medical Expenditure Panel Survey from 2001 to 2005. Indirect costs of CVD included lost productivity from morbidity and early mortality.
Dr. Heidenreich, chair of the writing group, had no financial conflicts to disclose. Several members of the writing group disclosed research funding from pharmaceutical companies including Boston Scientific, Eli Lilly and Company, Pfizer, Procter & Gamble, and Medtronic. Some members disclosed serving as consultants or advisory board members to companies including Sanofi-Aventis, Bristol Myers Squibb, and Daiichi Sankyo. Some members of the group received research support from organizations including the National Institutes of Health and the National Heart, Lung and Blood Institute.