Cardiovascular disease retains top billing

December 31, 2001

No. 1 cause of death, costs continue to rise

DALLAS, Dec. 31 - Cardiovascular disease remains the major cause of death and leading drain on the nation's healthcare dollars, according to the American Heart Association's 2002 Heart and Stroke Statistical Update, an annual report released today.

An estimated 61,800,000 Americans have cardiovascular disease (CVD). Cardiovascular diseases include, among others, high blood pressure, coronary heart disease (heart attack and angina), stroke, congenital heart defects and congestive heart failure. In 1999, the most recent year for which data is available, CVD claimed 958,775 lives in the United States, which is 40.1 percent of all deaths.

The costs of CVD continue to rise. The costs for 2001 were estimated at $298.2 billion. In 2002, costs are estimated to be $329.2 billion. Of this amount, $199.5 billion is nursing home costs, physician and professional services, drugs and other medical durables, and home health care. Indirect costs (mortality and lost productivity) total $129.7 billion.

A substantial amount of money was paid to Medicare beneficiaries for cardiovascular diseases. In 1998, payments totaled $26.4 billion (an average of $7,937 per hospital discharge). Also in 1998, $3.6 billion was paid to Medicare beneficiaries discharged from short-stay hospitals for stroke - an average of $5,912 per discharge.

New quality-of-care measurements

A new section reports the status of five quality-of-care performance measures from the National Committee for Quality Assurance (NCQA). They include advising smokers to quit, use of beta blockers after a heart attack, cholesterol screening in patients with coronary heart disease (CHD), cholesterol control in patients with CHD, and control of high blood pressure. These measurements also project how many additional lives could be saved if quality-of-care standards were practiced at the 90th percentile.

"By measuring the quality of care based on these standards, we may be better able to allocate our resources in fighting to reduce disability and death caused by heart disease and stroke," says David Faxon, M.D., president of the American Heart Association.

Smoking: The Update reports that in 1999, 65.3 percent of smokers were advised to quit, an increase from 61 percent in 1996. If this level increased to 73 percent, the benchmark set by the NCQA, an estimated 2.7 million additional smokers would be advised to quit, and 82,000 more smokers would actually quit smoking. This would lead to substantial reductions in smoking-related illness and healthcare costs.

Heart attack: In 1999, 85 percent of heart attack survivors were receiving a beta blocker when they were discharged from the hospital, an increase from 62.2 percent in 1996. If recommended practices were performed at the 90th percentile, an additional 4,000 deaths could be avoided each year. Also, 68.9 percent of patients hospitalized for heart attack, bypass surgery or angioplasty were screened for LDL cholesterol levels between 60 and 365 days following hospital discharge.

"The improvements in prescribing beta blockers are encouraging, and well over half of patients are getting their cholesterol screened, but there is no reason these practices shouldn't be at 100 percent," says Faxon. "These practices are key first steps in preventing a second heart attack."

Cholesterol awareness

The prevalence of cholesterol screening (measured during the five years preceding the reporting year) increased from 67.3 percent in 1991 to 70.8 percent in 1999. For people in the 47 states that participated in the Behavioral Risk Factor Surveillance System (BRFSS) study, the prevalence of high blood cholesterol awareness increased from 25.7 percent in 1991 to 28.6 percent in 1999. The BRFSS is an ongoing study conducted by the Centers for Disease Control and Prevention.

Update on stroke

Strokes killed 167,366 people in 1999. When considered separately from other cardiovascular diseases, stroke remains the third leading cause of death overall, behind diseases of the heart and all forms of cancer. From 1989 to 1999 the age-adjusted stroke death rate fell 13 percent.

High blood pressure still common

About 50 million Americans age six and older have high blood pressure(HBP). HBP is defined as systolic pressure (the top number in a blood pressure reading) of 140 mm Hg or higher, or diastolic pressure (bottom number) of 90 mm Hg or higher, or taking antihypertensive medicine. From 1989-1999 the age-adjusted death rate from HBP increased 21 percent. The actual number of deaths rose 46 percent. Disease code changes

This year's Update includes a new disease classification code. An additional cause-of-death category, "atherosclerotic cardiovascular disease, so described," is now part of the coding of coronary heart disease. That means in 1999 there were 529,659 deaths from CHD compared with 459,841 in 1998, but most of the increase was due to the addition of that cause-of-death term.
Editor's Note: The American Heart Association's Get With The GuidelinesSM program is a hospital-based quality-of-care improvement initiative to reduce the risk of recurrent heart attacks and strokes in patients with coronary and other vascular diseases. The program ensures that coronary artery disease patients receive appropriate risk-reduction therapies before being discharged as outlined in the AHA/ACC secondary prevention guidelines. For more information logon to

Carole Bullock: (214) 706-1279
Maggie Francis: (214) 706-1397

American Heart Association

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