US Pharm. 2013;38(2):6.
Hypertension, congestive heart failure, and coronary heart disease
were the three most frequent cardiovascular diseases (CVDs) affecting
the U.S. population (76.4 million, 16.3 million, and 16.3 million,
respectively) in 2009. According to the 2012 National Institutes of
Health report, 37.5% of the 1.3 million annual cases of heart attack
were recurrent; stroke had a recurrence rate of 23.3%. CVD patients
received the greatest number of days of hospital care (28.7 million).
Risk Factors and Death: According to a CDC
report, high blood pressure, high LDL cholesterol, and smoking are key
risk factors for heart disease, and 49% of adults have at least one of
these three risk factors. Only one in three adults with high LDL
cholesterol has the condition under control, and less than one-half of
adults with high LDL cholesterol receive treatment. Chronic heart
disease limited activity in 4.2 million adults. Heart disease was the
leading cause of death in individuals aged 65 years and older; it was
the second leading cause in those aged 45 to 64 years, and the third
leading cause in those aged 25 to 44 years. High blood pressure was a
primary or contributing cause of death in nearly 1,000 deaths per day.
CVD was the most frequent cause of death (244.8 per 100,000 population)
for all ethnic groups except Asian, Indian, and Hispanic females, in
whom CVD was exceeded only by cancer as the cause of death.
Associated Costs: Of the total cost of care for
all CVD patients ($297.7 billion), 60% ($179.3 billion) was for direct
expenses. For hypertension, the direct expense was 93.7% of its total
cost of care ($50.6 billion). However, in the case of both heart disease
and stroke, there was an equal split between direct and indirect
expenses. For all types of CVD, of the $33 billion spent on prescription
drugs, 3.6% was for the treatment of stroke, 27.3% was for heart
disease, and 64.5% was for hypertension. Of the $19.5 billion cost of
providing home health care to all CVD patients, 39% was for heart
disease, 30% was for stroke, and 26% was for hypertension. Of the $36.4
billion paid to office-based providers for care to CVD patients, 82.1%
was for services for patients with heart disease (46.4%) and
hypertension (35.7%). For CVD patients, emergency department and
in-patient hospital costs constituted one-half of the total cost of
care. For hypertension, a prescription drug ($21.3 billion) was the
highest cost category, followed by the cost of outpatient care ($13
billion) and then emergency and inpatient care ($7.9 billion).
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