Circulation. 2008;117:e25-e146
Published online before print December 17, 2007,
doi: 10.1161/CIRCULATIONAHA.107.187998
(Circulation. 2008;117:e25-e146.)
© 2008 American Heart Association, Inc.
Heart Disease and Stroke Statistics—2008 Update
A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Writing Group Members;
Wayne Rosamond, PhD, FAHA;
Katherine Flegal, PhD*;
Karen Furie, MD;
Alan Go, MD;
Kurt Greenlund, PhD*;
Nancy Haase;
Susan M. Hailpern, DrPH, MS;
Michael Ho, MD, PhD;
Virginia Howard, MSPH, FAHA;
Bret Kissela, MD;
Steven Kittner, MD;
Donald Lloyd-Jones, MD, FAHA;
Mary McDermott, MD;
James Meigs, MD;
Claudia Moy, PhD;
Graham Nichol, MD;
Christopher O’Donnell, MD, MPH, FAHA;
Veronique Roger, MD;
Paul Sorlie, PhD;
Julia Steinberger, MD, MSC;
Thomas Thom;
Matt Wilson, MD;
Yuling Hong, MD, PhD, FAHA, for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
 |
Table of Contents
|
|---|
- Summary...e26
- 1. About These Statistics...e28
- 2. Cardiovascular Diseases...e31
- 3. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris...e50
- 4. Stroke...e61
- 5. High Blood Pressure...e76
- 6. Congenital Cardiovascular Defects...e82
- 7. Heart Failure...e86
- 8. Other Cardiovascular Diseases...e90
- — Arrhythmias (Disorders of Heart Rhythm)...e90
- — Arteries, Diseases of (Including Peripheral Arterial Disease)...e91
- — Bacterial Endocarditis...e92
- — Cardiomyopathy...e93
- — Rheumatic Fever/Rheumatic Heart Disease...e93
- — Valvular Heart Disease...e93
- — Venous Thromboembolism...e93
- 9. Risk Factor: Smoking/Tobacco Use...e97
- 10. Risk Factor: High Blood Cholesterol and Other Lipids...e102
- 11. Risk Factor: Physical Inactivity...e106
- 12. Risk Factor: Overweight and Obesity...e109
- 13. Risk Factor: Diabetes Mellitus...e113
- 14. End-Stage Renal Disease and Chronic Kidney Disease...e120
- 15. Metabolic Syndrome...e123
- 16. Nutrition...e125
- 17. Quality of Care...e128
- 18. Medical Procedures...e133
- 19. Economic Cost of Cardiovascular Diseases...e137
- 20. At-a-Glance Summary Tables...e139
- — Males and Cardiovascular Diseases...e139
- — Females and Cardiovascular Diseases...e140
- — Ethnic Groups and Cardiovascular Diseases...e141
- — Children, Youth, and Cardiovascular Diseases...e142
- 21. Glossary ...e143
- Disclosures...e146
- Appendix I: List of Statistical Fact Sheets. URL: http://www.americanheart.org/presenter.jhtml?identifier=2007
|
Acknowledgments
|
|---|
We thank Drs Robert Adams, Gary Friday, Philip Gorelick, and
Sylvia Wasserthiel-Smoller, members of Stroke Statistics Subcommittee;
Drs Joe Broderick, Brian Eigel, Kimberlee Gauveau, Jane Khoury,
Jerry Potts, Jane Newburger, and Kathryn Taubert; and Sean Coady
and Michael Wolz for their valuable comments and contributions.
We acknowledge Tim Anderson and Tom Schneider for their editorial
contributions and Karen Modesitt for her administrative assistance.
Summary
Each year the American Heart Association, in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media, the lay public, and many others who seek the best national data available on disease and risk factor prevalence, disease incidence, and mortality rates in a single document. This year’s edition includes several areas not covered in previous editions. Below are a few highlights from this year’s Update in the areas of cardiovascular disease (CVD) mortality, control of risk factors, kidney disease, and medical care.
Death rates from CVD have declined, yet the burden of disease remains high.
- The 2004 overall death rate from CVD (International Classification of Diseases 10, I00–I99) was 288.0 per 100 000. The rates were 335.1 per 100 000 for white males, 454.0 per 100 000 for black males, 238.0 per 100 000 for white females, and 333.6 per 100 000 for black females. From 1994 to 2004, death rates from CVD (International Classification of Diseases 10, I00–I99) declined 24.7%. Preliminary mortality data from 2005 show that CVD (I00–I99; Q20–Q28) accounted for 35.2% (861 826) of all 2 447 910 deaths in 2005, or 1 of every 2.8 deaths in the United States.
- Nearly 2400 Americans die of CVD each day—an average of 1 death every 37 seconds. The 2005 overall preliminary death rate from CVD was 279.2. More than 148 000 Americans killed by CVD (I00–I99) in 2004 were <65 years of age. In 2004, 32% of deaths from CVD occurred before the age of 75 years, which is well before the average life expectancy of 77.9 years.
- Coronary heart disease caused 1 of every 5 deaths in the United States in 2004. Coronary heart disease mortality was 451 326. In 2008, an estimated 770 000 Americans will have a new coronary attack, and about 430 000 will have a recurrent attack. It is estimated that an additional 175 000 silent first myocardial infarctions occur each year. About every 26 seconds, an American will have a coronary event, and about every minute someone will die from one.
- Each year, about 780 000 people experience a new or recurrent stroke. About 600 000 of these are first attacks, and 180 000 are recurrent attacks. Preliminary data from 2005 indicate that stroke accounted for about 1 of every 17 deaths in the United States. On average, every 40 seconds someone in the United States has a stroke. From 1994 to 2004, the stroke death rate fell 24.2%, and the actual number of stroke deaths declined 6.8%.
- In 2004, 1 in 8 death certificates (284 365 deaths) in the United States mentions heart failure.
Control of risk factors remains an issue for many Americans.
- The age-adjusted prevalence of high low-density lipoprotein cholesterol in US adults was 26.6% in 1988–1994 and 25.3% in 1999–2004. Between 1988–1994 and 1999–2004, awareness increased from 39.2% to 63.0%, and use of pharmacological lipid-lowering treatment increased from 11.7% to 40.8%. Low-density lipoprotein cholesterol control increased from 4.0% to 25.1% among those with high low-density lipoprotein cholesterol.
- Overall, 62.0% of adults
18 years of age engaged in at least some vigorous and/or light-moderate leisure-time physical activity lasting 10 minutes per session. In 2002–2004, 40.2% of people 75 years of age (age adjusted) engaged in at least some regular leisure-time physical activity. Men were more likely (64.0%) to exercise than were women (60.2%).
- More than 9 million children and adolescents between 6 and 19 years of age are considered overweight on the basis of being in the 95th percentile or higher of body mass index values in the 2000 Centers for Disease Control and Prevention growth chart.
- On the basis of data from the National Health and Nutrition Examination Survey, the prevalence of overweight in children between 6 and 11 years of age increased from 4.0% in 1971–1974 to 17.5% in 2001–2004. The prevalence of overweight in adolescents between 12 and 19 years of age increased from 6.1% to 17.0%. In 2003–2004, 36% of women 65 to 74 years of age and 24% of women 75 years of age were obese. This is an increase from 1988–1994, when 27% of women 65 to 74 years of age and 19% of women 75 years of age were obese. For men, from 1988–1994, 24% of those 65 to 74 years of age and 13% of those 75 years of age were obese, compared with 33% of those 65 to 74 years of age and 23% of those 75 years of age in 2003–2004.
- One and a half million new cases of diabetes were diagnosed in people 20 years of age in 2005.
The 2008 Update expands data coverage of CVD-related kidney disease.
- End-stage renal disease and chronic kidney disease are conditions that are most commonly associated with diabetes and/or high blood pressure and occur when the kidneys can no longer function normally on their own.
- The incidence of reported end-stage renal disease has almost doubled in the past 10 years. In 2004, 104 364 new cases of end-stage renal disease were reported.
- The number of persons treated for end-stage renal disease increased from 68 757 in 1994 to 102 356 in 2004; this translates to 261.3 per million in 1994 to 348.6 per million in 2004.
- The US Renal Data System estimates that by 2010, 650 000 Americans will require treatment for kidney failure, which represents a 60% increase over the number who received such treatment in 2001.
- The prevalence of chronic kidney disease (stages I–V) is 16.8%. This represents an increase over the 14.5% prevalence estimate from the National Health and Nutrition Examination Survey 1988–1994.
- The prevalence of chronic kidney disease was greater among those with diabetes (40.2%), hypertension (24.6%), and CVD (28.2%) than among those without these chronic conditions.
Improvements in medical care are being made.
- Over a 3-year period from 2002 through 2004, among 159 168 patients admitted with heart failure at 285 hospitals, inotrope use decreased, and improvements were made in providing discharge instructions, smoking counseling, left ventricular assessment, and β-blocker prescription.
- During this same period of time, clinical outcomes improved, including the need for mechanical ventilation (5.3% to 3.4%), length of stay (mean, 6.3 days to 5.5 days), and in-hospital death rate (4.5% to 3.2%).
The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current data available in the Statistics Update. The 2005 preliminary mortality data have been released, and although not included in this year’s Update, more information can be found at the National Center for Health Statistics Web site, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm.
1. About These Statistics
The American Heart Association (AHA) works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS); the National Heart, Lung, and Blood Institute (NHLBI); the National Institute of Neurological Disorders and Stroke (NINDS); and other government agencies to derive the annual statistics in this Update. This chapter describes the most important sources and the types of data we use from them. For more details and an alphabetical list of abbreviations, see Chapter 21 of this document, the Glossary and Abbreviation Guide.
The surveys used are:
- Behavioral Risk Factor Surveillance Survey (BRFSS)—ongoing telephone health survey system
- Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)—stroke incidence rates and outcome within a biracial population
- Medical Expenditure Panel Survey (MEPS)—data on specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid for
- National Health and Nutrition Examination Survey (NHANES)—disease and risk factor prevalence and nutrition statistics
- National Health Interview Survey (NHIS)—disease and risk factor prevalence
- National Hospital Discharge Survey (NHDS)—hospital inpatient discharges (discharged alive, dead, or status unknown)
- National Ambulatory Medical Care Survey (NAMCS)—physician office visits
- National Hospital Ambulatory Medical Care Survey (NHAMCS)—hospital outpatient and emergency department visits
- National Inpatient Sample (NIS) of the Agency for Health Research and Quality—hospital inpatient discharges and charges
- National Institute of Neurological Disorders and Stroke (NINDS)—brain and nervous system disorders
- National Nursing Home Survey (NNHS)—nursing home visits
- National Vital Statistics—national and state mortality data
- World Health Organization (WHO)—country mortality
- Youth Risk Behavior Surveillance (YRBS)—trends for 6 categories of priority health-risk behaviors in youth and young adults
|
Disease Prevalence
|
|---|
Prevalence is an estimate of how many people have a disease
at a given point or period in time. The NCHS conducts health
examination and health interview surveys that provide estimates
of the prevalence of diseases and risk factors. In this Update,
the health interview part of the NHANES is used for the prevalence
of cardiovascular diseases (CVD). NHANES is used more than the
NHIS because in NHANES, angina pectoris (AP) is based on the
Rose Questionnaire; estimates are made regularly for heart failure
(HF); hypertension is based on blood pressure (BP) measurements
and interviews; and an estimate can be made of total CVD to
include myocardial infarction (MI), AP, HF, stroke, and hypertension.
A major emphasis of this Update is to present the latest estimates of the number of persons in the United States who have specific conditions in order to provide a more realistic estimate of burden. Most estimates based on NHANES prevalence rates use data collected from 1999 to 2004 (in most cases, these are the latest published figures). These are applied to census population estimates for 2005. Differences in population estimates based on extrapolations of rates beyond the data collection period by using more recent census population estimates cannot be used to evaluate possible trends in prevalence. Trends can only be evaluated by comparing prevalence rates estimated from surveys conducted in different years.
|
Risk Factor Prevalence
|
|---|
The NHANES 1999–2004 data are used in this Update to present
estimates of the percentage of persons with high lipid values,
diabetes, overweight, and obesity. The NHIS is used for the
prevalence of cigarette smoking and physical inactivity. Data
for students in grades 9 through 12 are obtained from the Youth
Risk Factor Surveillance System.
|
Incidence and Recurrent Attacks
|
|---|
An incidence rate refers to the number of new cases of a disease
that develop in a population per unit of time. The unit of time
is not necessarily 1 year, although we often discuss incidence
in terms of 1 year. For some statistics, new and recurrent attacks
or cases are combined. Our national incidence estimates for
the various types of CVD are extrapolations to the US population
from the Framingham Heart Study (FHS), the Atherosclerosis Risk
in Communities (ARIC) study, the Cardiovascular Health Study
(CHS) conducted by the NHLBI, and the Greater Cincinnati/Northern
Kentucky Stroke Study (GCNKSS) funded by the NINDS. The rates
change only when new data are available; they are not computed
annually. Do not compare the incidence or the rates with those
in past editions of the Heart and Stroke Statistical Update
(renamed the Heart Disease and Stroke Statistics Update). Doing
so can lead to serious misinterpretation of time trends.
|
Mortality
|
|---|
Mortality data are grouped according to the underlying cause
of death. "Total-mention" mortality is the number of death certificates
in 2004 that mention the given disease classification either
as the underlying cause or as a contributing cause. These were
final 2004 data unless otherwise indicated. For many deaths
classified as attributable to CVD, selection of the most likely
single underlying cause can be difficult when several major
comorbidities are present, as is often the case in the elderly
population. It is, therefore, useful to know the extent of mortality
from a given cause, regardless of whether it is the underlying
cause or a contributing cause—ie, its "total mentions."
In all comparisons of deaths and death rates between 1994 and
2004, 1994 data were modified using appropriate comparability
ratios.
The first text section for each disease listed in this Update mentions mortality information. This includes the number of deaths for which the disease is the underlying cause; this is referred to as "mortality." That number is followed by "total-mention mortality." All other numbers or rates of deaths in the Update refer to the given disease as the underlying cause. The one exception, heart failure, is explained in that section.
National and state mortality data presented according to the underlying cause of death are computed from the Data Warehouse mortality tables of the NCHS Web site or the compressed CDC file. Total-mention numbers of deaths are tabulated from the electronic mortality files of the NCHS Web site.
|
Population Estimates
|
|---|
In this publication, we have used national population estimates
from the US Census Bureau for 2005 in the computation of morbidity
data. Data for 2004 are used in the computation of death rates.
The Census Bureau Web site contains these data as well as information
on the file layout.
1
|
Hospital Discharges and Ambulatory Care Visits
|
|---|
Estimates of the numbers of hospital discharges and numbers
of procedures performed are for inpatients discharged from short-stay
hospitals. Discharges include those discharged alive, dead,
or with unknown status. Unless otherwise specified, discharges
are according to the first-listed (primary) diagnosis, and procedures
are listed according to the all-listed diagnosis (primary plus
secondary). These estimates are from the NHDS of the NCHS unless
otherwise noted. Ambulatory care visits include patient visits
to hospital emergency or outpatient departments and to physicians’
offices.
|
International Classification of Diseases
|
|---|
Morbidity (illness) and mortality (death) data in the United
States use a standard classification system: the International
Classification of Diseases (ICD). About every 10 to 20 years,
the ICD codes are revised to reflect changes over time in medical
technology, diagnosis, or terminology. Where necessary for comparability
of mortality trends across the 9th and 10th ICD revisions, comparability
ratios computed by NCHS are applied as noted.
2 Effective with
mortality data for 1999, we are using the 10th revision (ICD-10).
It will be a few more years before the 10th revision is used
for hospital discharge data, which are based on the International
Classification of Diseases, Clinical Modification, Ninth Revision
(ICD-9-CM).
3
|
Age Adjustment
|
|---|
Prevalence and mortality estimates for the United States or
individual states comparing demographic groups or estimates
over time either are age specific or are age adjusted to the
2000 standard population by the direct method.
4 International
mortality data are age adjusted to the European standard.
5 Unless
otherwise stated, all death rates in this publication are age
adjusted and are per 100 000 population.
|
Data Years for National Estimates
|
|---|
In this Update we estimate the annual number of new (incidence)
and recurrent cases of a disease in the United States by extrapolating
to the US population in 2005 from rates reported in a community-
or hospital-based study or multiple studies. Age-adjusted
incidence rates by sex and race are also given in this report as observed
in the study or studies. For US
mortality, most numbers and
rates are for 2004. For disease and risk factor
prevalence,
most rates in this report are calculated from the 1999–2004
NHANES. Rates by age and sex are also applied to the US population
in 2005 to estimate the numbers of persons with the disease
or risk factor in that year. Because NHANES is conducted only
in the noninstitutionalized population, we extrapolated the
rates to the total US population in 2005, recognizing that this
probably underestimates total prevalence given the relatively
high prevalence in the institutionalized population. The numbers
and rates of
hospital inpatient discharges for the United States
are for 2005, as are many of the numbers of
physician office visits and
visits to hospital emergency and
outpatient departments.
Except as noted,
economic cost estimates are projected to 2008.
|
Cardiovascular Disease
|
|---|
For data on hospitalizations, physician office visits, and mortality,
CVD is defined according to ICD codes given in Chapter 21 of
the present document. This definition includes all diseases
of the circulatory system and congenital CVD. Unless so specified,
an estimate for total CVD does not include congenital CVD.
|
Race
|
|---|
Data published by governmental agencies for some racial groups
are considered unreliable because of the small sample size in
the studies. Because we try to provide data for as many racial
groups as possible, we show these data for informational and
comparative purposes.
|
Contacts
|
|---|
If you have questions about statistics or any points made in
this Update, please contact the Biostatistics Program Coordinator
at the American Heart Association National Center (e-mail nancy.haase@heart.org,
phone 214-706-1423). Direct all media inquiries to News Media
Relations at inquiries@heart.org or 214-706-1173.
We do our utmost to ensure that this Update is error free. If we discover errors after publication, we will provide corrections at our Web site, http://www.americanheart.org/statistics, and in the journal Circulation.
See the Glossary for an explanation of terms.
|
References
|
|---|
1. US Census Bureau population estimates. Available at: http://www.census.gov/popest/national/asrh/2006_nat_res.html. Accessed September 2007.
2. National Center for Health Statistics. Health, United States, 2006, With Chartbook on Trends in the Health of Americans. Hyattsville, Md: National Center for Health Statistics; 2006. Available at: http://www.cdc.gov/nchs/data/hus/hus05.pdf. Accessed October 25, 2006.
3. National Center for Health Statistics, Centers for Medicare and Medicaid Services. International Classification of Diseases, Ninth Revision. Clinical Modification (ICD-9-CM). Hyattsville, Md: National Center for Health Statistics; 1978.
4. Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. Natl Vital Stat Rep. 1998; 47: 1–16, 20.[Medline]
[Order article via Infotrieve]
5. World Health Organization. World Health Statistics Annual. Geneva, Switzerland: World Health Organization; 1998.
2. Cardiovascular Diseases
ICD-9 390–459, 745–747, ICD-10 I00–I99, Q20–Q28; see Glossary (Chapter 21) for details and definitions. See Tables 2-1 through 2-3
and Charts 2-1 through 2-20.
View this table:
[in this window]
[in a new window]
|
Table 2-2. 2004 Age-Adjusted Death Rates for CVD, CHD, and Stroke by State (Includes District of Columbia and Puerto Rico)
|
|
View this table:
[in this window]
[in a new window]
|
Table 2-3. International Death Rates (Revised 2007): Death Rates (Per 100 000 Population) for Total Cardiovascular Disease, Coronary Heart Disease, Stroke, and Total Deaths in Selected Countries (Most Recent Year Available)
|
|
View larger version (8K):
[in this window]
[in a new window]
|
Chart 2-1. Prevalence of CVD in adults 20 years of age according to age and sex (NHANES 1999–2004). Source: NCHS and NHLBI. These data include CHD, HF, stroke, and hypertension.
|
|
View larger version (7K):
[in this window]
[in a new window]
|
Chart 2-2. Incidence of CVD (CHD, HF, stroke, or intracerebral hemorrhage; does not include hypertension alone) by age and sex (FHS, 1980–2003). Source: NHLBI.2
|
|
View larger version (5K):
[in this window]
[in a new window]
|
Chart 2-3. Deaths due to diseases of the heart (United States: 1900–2005). See Glossary for an explanation of "disease of the heart." The 2005 mortality rate is preliminary. Source: Respective National Vital Statistic Reports; NCHS and NHLBI.
|
|
View larger version (12K):
[in this window]
[in a new window]
|
Chart 2-5. Percentage breakdown of deaths due to CVD (United States: 2004). Source: NCHS and NHLBI. *Not a true underlying cause.
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-7. CVD and other major causes of death: total, <85 years of age, and 85 years of age. Deaths among both sexes, United States, 2004. Source: NCHS and NHLBI.
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-8. CVD and other major causes of death: total, <85 years of age, and 85 years of age. Deaths among males, United States, 2004. Source: NCHS and NHLBI.
|
|
View larger version (9K):
[in this window]
[in a new window]
|
Chart 2-9. CVD and other major causes of death: total, <85 years of age, and 85 years of age. Deaths among females, United States, 2004. Source: NCHS and NHLBI.
|
|
View larger version (8K):
[in this window]
[in a new window]
|
Chart 2-10. CVD and other major causes of death for all males and females (United States: 2004). A indicates total CVD; B, cancer; C, accidents; D, CLRD; E, diabetes mellitus; and F, Alzheimer’s. Source: NCHS and NHLBI.
|
|
View larger version (7K):
[in this window]
[in a new window]
|
Chart 2-11. CVD and other major causes of death for white males and females (United States: 2004). A indicates total CVD plus congenital HD; B, cancer; C, accidents; D, CLRD; E, diabetes mellitus; and F, Alzheimer’s. Note: Using "diseases of heart and stroke," which do not constitute total CVD, would make the percentages for the "A" bars 32.6 for males and 34.8 for females. Source: NCHS and NHLBI.
|
|
View larger version (7K):
[in this window]
[in a new window]
|
Chart 2-12. CVD and other major causes of death for black males and females (United States: 2004). A indicates total CVD plus congenital HD; B, cancer; C, accidents; D, assault (homicide); E, diabetes mellitus; and F, nephritis, etc. Note: Using "diseases of heart and stroke," which do not constitute total CVD, would make the percentages for the "A" bars 30.1 for males and 34.3 for females. Source: NCHS and NHLBI.
|
|
View larger version (7K):
[in this window]
[in a new window]
|
Chart 2-13. Diseases of the heart and stroke and other major causes of death for Hispanic or Latino males and females (United States: 2004). Data for total CVD are not available. A indicates diseases of the heart and stroke; B, cancer; C, accidents; D, diabetes mellitus; E, assault (homicide); and F, influenza and pneumonia. Source: NCHS and NHLBI.
|
|
View larger version (7K):
[in this window]
[in a new window]
|
Chart 2-14. Diseases of the heart and stroke and other major causes of death for Asian or Pacific Islander males and females (United States: 2004). "Asian or Pacific Islander" is a heterogenous category that includes people at high CVD risk (eg, South Asian) and people at low CVD risk (eg, Japanese). More specific data for these groups are not available. Mortality data for total CVD are not available. A indicates diseases of the heart and stroke; B, cancer; C, accidents; D, CLRD; E, diabetes mellitus; and F, influenza and pneumonia. Source: NCHS and NHLBI.
|
|
View larger version (7K):
[in this window]
[in a new window]
|
Chart 2-15. Diseases of the heart and stroke and other major causes of death for American Indian or Alaska Native males and females (United States: 2004). Data for total CVD are not available. A indicates diseases of the heart and stroke; B, cancer; C, accidents; D, diabetes mellitus; and E, chronic liver disease and cirrhosis. Source: NCHS and NHLBI.
|
|
View larger version (8K):
[in this window]
[in a new window]
|
Chart 2-16. Age-adjusted death rates for CHD, stroke, and lung and breast cancer for white and black females (United States: 2004). Source: NCHS and NHLBI.
|
|
View larger version (10K):
[in this window]
[in a new window]
|
Chart 2-17. CVD mortality trends for males and females (United States: 1979–2004). Source: Annual Final Mortality, NCHS and NHLBI. The overall comparability for CVD between ICD-9 (1979–1998) and ICD-10 (1999–2004) is 0.9962. No comparability ratios were applied.
|
|
View larger version (10K):
[in this window]
[in a new window]
|
Chart 2-18. Percentage of foreign-born Hispanics, 18 years of age, with selected health conditions, by length of time living in the United States, 1998–2003. In this chart, CVD excludes hypertension. Source: MMWR.58
|
|
View larger version (6K):
[in this window]
[in a new window]
|
Chart 2-19. Hospital discharges for CVD (United States: 1970–2005). Hospital discharges include people discharged alive, dead, and "status unknown." Source: NCHS and NHLBI.
|
|
|
Prevalence
|
|---|
An estimated 80 700 000 American adults (1 in 3) have 1 or more
types of CVD. Of these, 38 200 000 are estimated to be
60 years
of age (extrapolated to 2005 from NCHS NHANES 1999–2004
data). (Total CVD includes diseases listed in the bullet points
below except for congenital CVD.) Because of overlap, it is
not possible to add these conditions to arrive at a total.
- High blood pressure (HBP)—73 000 000. (Defined as systolic pressure 140 mm Hg and/or diastolic pressure 90 mm Hg, taking antihypertensive medication, or being told at least twice by a physician or other health professional that one has HBP.)
- Coronary heart disease (CHD)—16 000 000.
- — Myocardial infarction (MI) (heart attack)— 8 100 000.
- — Angina pectoris (AP) (chest pain)—9 100 000.
- Heart failure (HF)—5 300 000.
- Stroke—5 800 000.
- Congenital cardiovascular defects—650 000 to 1 300 000 (see Chapter 6).
The following prevalence estimates are for people 18 years of age from NHIS, NCHS 2005.1 Note: Hypertension estimates reflect only those aware that they have hypertension.)
- — Among whites only, 12.0% have heart disease (HD), 6.6% have CHD, 21.0% have hypertension, and 2.3% have had a stroke.
- — Among blacks or African Americans, 10.2% have HD, 6.2% have CHD, 31.2% have hypertension, and 3.4% have had a stroke.
- — Among Hispanics or Latinos, 8.3% have HD, 5.9% have CHD, 20.3% have hypertension, and 2.2% have had a stroke.
- — Among Asians, 6.7% have HD, 3.8% have CHD, 19.4% have hypertension, and 2.0% have had a stroke.
- — Among Native Hawaiians or other Pacific Islanders, 22.4% have hypertension. (Other racial prevalence estimates are considered unreliable.)
- — Among American Indians or Alaska Natives, 13.0% have HD,* 2.5% have CHD, 25.5% have hypertension,* and 5.8% have had a stroke.
|
Incidence
|
|---|
- On the basis of the NHLBI’s Framingham Heart Study (FHS) original and offspring cohort data from 1980 to 20032:
- — The average annual rates of first cardiovascular events rise from 3 per 1000 men at 35 to 44 years of age to 74 per 1000 men at 85 to 94 years of age. For women, comparable rates occur 10 years later in life. The gap narrows with advancing age.
- — Before 75 years of age, a higher proportion of CVD events due to CHD occur in men than in women, and a higher proportion of events due to stroke occur in women than in men.
- Among American Indian men 45 to 74 years of age, the incidence of CVD ranges from 15 to 28 per 1000 population. Among women, it ranges from 9 to 15 per 1000.3
- Data from the FHS indicate that the lifetime risk for CVD is 2 in 3 for men and more than 1 in 2 for women at 40 years of age (personal communication, Donald Lloyd-Jones, MD, Northwestern University, Chicago, Ill).
|
Mortality
|
|---|
ICD-10 I00–I99, Q20–Q28 for CVD (CVD mortality includes congenital cardiovascular defects); C00–C97 for cancer; C33–C34 for lung cancer; C50 for breast cancer; J40–J47 for chronic lower respiratory disease (CLRD); G30 for Alzheimer’s disease; E10–E14 for diabetes; and V01–X59, Y85–Y86 for accidents.
- Mortality data show that CVD (I00–I99, Q20–Q28) as the underlying cause of death (includes congenital cardiovascular defects) accounted for 36.3% (869 724) of all 2 397 615 deaths in 2004, or 1 of every 2.8 deaths in the United States. CVD total mentions (1 357 000 deaths in 2004) constituted approximately 57% of all deaths that year.4
- In every year since 1900 except 1918, CVD accounted for more deaths than any other major cause of death in the United States.5,6
- Nearly 2400 Americans die of CVD each day, an average of 1 death every 37 seconds. CVD claims approximately as many lives each year as cancer, CLRD, accidents, and diabetes mellitus combined.4
- The 2004 overall death rate due to CVD (I00–I99) was 288.0. The rates were 335.1 for white males, 454.0 for black males, 238.0 for white females, and 333.6 for black females. From 1994 to 2004, death rates due to CVD (ICD-10 I00–I99) declined 24.7%. In the same 10-year period, actual CVD deaths declined 8%.4
- Among other causes of death in 2004, cancer caused 553 888 deaths; accidents, 112 012; Alzheimer’s disease, 65 965; and HIV (human immunodeficiency virus)/AIDS (acquired immune deficiency syndrome), 13 063.4
- The 2004 CVD (I00–I99) death rates were 341.7 for males and 245.3 for females. Death rates for cancer (malignant neoplasms) were 227.7 for males and 157.4 for females. Breast cancer claimed the lives of 40 954 females in 2004; lung cancer claimed 68 461. Death rates for females were 24.4 for breast cancer and 41.6 for lung cancer. One in 30 female deaths was of breast cancer, whereas 1 in 6 was of CHD. For comparison, 1 in 4.6 females died of cancer, whereas 1 in 2.6 died of CVD. On the basis of 2004 mortality data, CVD caused approximately 1 death per minute among females, or approximately 460 000 female lives in 2004. That represents more female lives than were claimed by cancer, CLRD, Alzheimer’s disease, accidents, and diabetes mellitus combined.4
- More than 148 000 Americans killed by CVD (I00–I99) in 2004 were <65 years of age. In 2004, 32% of deaths due to CVD occurred before the age of 75 years, which is well before the average life expectancy of 77.9 years.4
- In 2004, death rates for diseases of the heart in American Indians or Alaska Natives were 182.7 for males and 119.9 for females; for Asians or Pacific Islanders, they were 146.5 for males and 96.1 for females; for Hispanics or Latinos, they were 193.9 for males and 130.0 for females.7
- According to the NCHS, if all forms of major CVD were eliminated, life expectancy would rise by almost 7 years. If all forms of cancer were eliminated, the gain would be 3 years. According to the same study, the probability at birth of eventually dying of major CVD (I00–I78) is 47%, and the chance of dying of cancer is 22%. Additional probabilities are 3% for accidents, 2% for diabetes mellitus, and 0.7% for HIV.8
- In 2004, the leading causes of death in women 65 years of age were diseases of the heart (1), cancer (2), and stroke (3). In older men, they were diseases of the heart (1), cancer (2), CLRD (3), and stroke (4).9
- A recent study of the decrease in US deaths due to CHD from 1980 to 2000 suggests that approximately 47% of the decrease was attributed to evidence-based medical therapies and 44% to changes in risk factors in the population.10
|
Out-of-Hospital Cardiac Arrest
|
|---|
There is a wide variation in the reported incidence of and outcome
for out-of-hospital cardiac arrest. These differences are due
in part to differences in definition and ascertainment of cardiac
arrest data, as well as differences in treatment after the onset
of cardiac arrest.
Cardiac arrest is defined as cessation of cardiac mechanical activity and is confirmed by the absence of signs of circulation.11 Available epidemiological databases do not adequately characterize cardiac arrest or the subset of cases that occur with sudden onset. The following information summarizes representative data from several sources in an attempt to characterize the incidence and outcome of out-of-hospital cardiac arrest.
- According to NCHS Data Warehouse mortality data, 310 000 CHD deaths occur out of hospital or in hospital emergency departments (EDs) annually (2004, ICD-10 codes I20–I25).12
- The annual incidence of out-of-hospital cardiac arrest in North America is approximately 0.55 per 1000 population.13,14 With an estimated US population of 302 196 872 (www.census.gov, accessed June 27, 2007), this implies that approximately 166 200 out-of-hospital cardiac arrests occur annually.
- Approximately 60% of unexpected cardiac deaths are treated by emergency medical services (EMS).15
- In a population 20 years of age, the incidence of out-of-hospital cardiac arrest treated by EMS is from 36 to 81 per 100 000.15,16
- — Of these, 20% to 38% have ventricular fibrillation or ventricular tachycardia as the first recorded rhythm.13,16
- The incidence of cardiac arrest with an initial rhythm of ventricular fibrillation is decreasing over time16; however, the incidence of cardiac arrest with any initial rhythm is not decreasing.16
- The median reported survival to discharge after out-of-hospital cardiac arrest with any first recorded rhythm is 6.4%.17
- The average proportion of cases of out-of-hospital cardiac arrest that receive bystander cardiopulmonary resuscitation is 27.4%.17
- The incidence of lay-responder defibrillation is low (2.05% in 2002) but increasing over time.18
- The reported incidences of out-of-hospital pediatric cardiac arrest vary widely (from 2.6 to 19.7 annual cases per 100 000).19
- In 2004, 5891 people died of unintentional choking or suffocation. Of these, 725 were <1 year of age (NCHS).
- For adults, the reported incidence of cardiac arrest in hospital was 0.17 (±0.09) per bed per year.20
- The rates of survival to discharge after in-hospital cardiac arrest are 27% among children and 18% among adults.21
Pediatric/Children
- There are 72 293 812 individuals <18 years of age in the United States22; this implies that there are from 1900 to 14 200 pediatric out-of-hospital cardiac arrests annually of all causes (including trauma, sudden infant death syndrome, respiratory causes, cardiovascular causes, and submersion).
- Ventricular fibrillation is an uncommon cause of cardiac arrest in children but is observed in approximately 5% to 15% of children with out-of-hospital cardiac arrest.23
- Studies that document voluntary reports of deaths among high school athletes suggest that the incidence of out-of-hospital cardiac arrest ranges from 0.28 to 1.0 deaths per 100 000 high school athletes annually nationwide.24,25 Although incomplete, these numbers provide a basis for estimating the number of deaths in this age range.
- One report describes the incidence of nontraumatic pediatric cardiac arrest (among students 3 and
18 years of age) that occurs in schools and estimates rates (per 100 000 person-school-years) for elementary, middle, and high schools to be 0.18, 0.19, and 0.15, respectively, for the geographic area (King County, Washington) and time frame (January 1, 1990, to December 31, 2005) studied.26
- The reported average rate of survival to discharge after pediatric out-of-hospital cardiac arrest is 6.7%.19
|
Awareness of Warning Signs and Risk Factors for CVD
|
|---|
- Surveys conducted by the American Heart Association in 1997, 2000, 2003, and 2006 to evaluate trends in women’s awareness, knowledge, and perceptions related to CVD found that in 2006, awareness of HD as the leading cause of death among women was 57%, significantly higher than in prior surveys. Awareness was lower among black and Hispanic women than among white women, and the racial/ethnic difference has not changed appreciably over time. More than twice as many women felt uninformed about stroke, compared with HD, in 2006. Hispanic women were more likely than white women to report that there is nothing they can do to keep themselves from getting CVD. The majority of respondents reported confusion related to basic CVD prevention strategies.27
- Nearly 875 students in 4 Michigan high schools were given a survey to obtain data on the perception of risk factors and other knowledge-based assessment questions about CVD. Accidents were rated as the greatest perceived lifetime health risk (39%). Nearly 17% selected CVD as the greatest lifetime risk, making it the third most popular choice after accidents and cancer. When asked to identify the greatest cause of death for each sex, 42% correctly recognized CVD for men, and 14% correctly recognized CVD for women; 40% incorrectly chose a substance abuse/use behavior, other than cigarettes, as the most important CVD risk behavior.28
- A nationally representative sample of women were given a questionnaire about history of CVD risk factors, self-reported actions taken to reduce risk, and barriers to heart health. The rate of awareness of CVD as the leading cause of death has nearly doubled since 1997, was significantly greater for whites than for blacks and Hispanics, and was independently correlated with increased physical activity (PA) and weight loss in the previous year. Fewer than half of respondents were aware of healthy levels of risk factors. Awareness that their personal level was not healthy was positively associated with action. Most women took steps to lower risk in family members and themselves.29
|
Risk Factors
|
|---|
- Data from the 2003 CDC BRFSS survey of adults 18 years of age showed the prevalence of respondents who reported having 2 risk factors for HD and stroke increased among successive age groups. The prevalence of having 2 risk factors was highest among blacks (48.7%) and American Indians/Alaska Natives (46.7%) and lowest among Asians (25.9%); prevalence was similar in women (36.4%) and men (37.8%). The prevalence of multiple risk factors ranged from 25.9% among college graduates to 52.5% among those with less than a high school diploma (or its equivalent). Persons reporting household income of $50 000 had the lowest prevalence (28.8%), and those reporting household income of $10 000 had the highest prevalence (52.5%). Adults who reported being unable to work had the highest prevalence (69.3%) of 2 risk factors, followed by retired persons (45.1%), unemployed adults (43.4%), homemakers (34.3%), and employed persons (34.0%). Prevalence of 2 risk factors varied by state/territory and ranged from 27.0% (Hawaii) to 46.2% (Kentucky). Twelve states and 2 territories had a multiple–risk-factor prevalence of 40%: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, Oklahoma, Tennessee, West Virginia, Guam, and Puerto Rico.30
- Data from the BRFSS (CDC) showed that young women and men 18 to 24 years of age had comparatively poor health profiles and experienced adverse changes from 1990 to 2000. After adjustment for education and income, these young people had the highest prevalence of smoking (34% to 36% current smokers among whites), the largest increases in smoking (10% to 12% among whites and 9% among Hispanic women), and large increases in obesity (4% to 9% increase in all groups). All groups had high levels of sedentary behavior (approximately 20% to 30%) and low vegetable or fruit intake (approximately 35% to 50%). In contrast, older Hispanics and older black men (65 to 74 years of age) showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women) and sedentary behavior (Hispanic women and black men) and the largest increases in vegetable or fruit intake (Hispanic women and black men).31
- Data from the Chicago Heart Association Detection Project (1967–1973, with an average follow-up of 31 years) showed that in younger women (18 to 39 years of age) with favorable levels for all 5 major risk factors (BP, serum cholesterol, body mass index [BMI], diabetes, and smoking), future incidence of CHD and CVD is rare, and long-term and all-cause mortality are much lower than for those who have unfavorable or elevated risk factor levels at young ages. Similar findings applied to men in this study.32,33
- Data from the BRFSS (CDC) showed that in adults 18 years of age, disparities were common in all risk factors examined. In men, the highest prevalence of obesity (29.7%) was found in Mexican Americans who had completed a high school education. Black women with or without a high school education had a high prevalence of obesity (48.4%). Hypertension prevalence was high among blacks (41.2%) regardless of sex or educational status. Hypercholesterolemia was high among white and Mexican-American men and white women regardless of educational status. CHD and stroke were inversely related to education, income, and poverty status. Hospitalization for total HD and acute MI was greater among men, but hospitalization for congestive heart failure (CHF) and stroke was greater among women. Among Medicare enrollees, CHF hospitalization was higher in blacks, Hispanics, and American Indians/Alaska Natives than among whites, and stroke hospitalization was highest in blacks. Hospitalizations for CHF and stroke were highest in the southeastern United States. Life expectancy remains higher in women than in men and in whites than in blacks by approximately 5 years. CVD mortality at all ages tended to be highest in blacks.34
- In respondents 18 to 74 years of age, data from the 2000 BRFSS (CDC) showed the prevalence of healthy lifestyle characteristics was as follows: no smoking, 76.0%; healthy weight, 40.1%; consumption of 5 fruits and vegetables per day, 23.3%; and regular PA, 22.2%. The overall prevalence of the healthy lifestyle indicators (ie, having all 4 healthy lifestyle characteristics) was only 3%, with little variation among subgroups.35
- Analysis of 5 cross-sectional, nationally representative surveys from NHES 1960–1962 to NHANES 1999–2000 showed that the prevalence of key risk factors (ie, high cholesterol, HBP, current smoking, and total diabetes) decreased over time across all BMI groups, with the greatest reductions observed among overweight and obese groups. Total diabetes prevalence was stable within BMI groups over time; however, the trend has leveled off or been reversed for some of the risk factors in more recent years.36
- Analysis of FHS data among participants free of CVD at the age of 50 years showed the lifetime risk for developing CVD was 51.7% for men and 39.2% for women. Median overall survival was 30 years for men and 36 years for women (see Table 2-4).37
- Analysis of >14 000 middle-aged subjects in the ARIC study of the NHLBI showed that >90% of CVD events in black subjects, compared with approximately 70% in white subjects, were explained by elevated or borderline risk factors. Furthermore, the prevalence of participants with elevated risk factors was higher in black subjects; after accounting for education and risk factors, the incidence of CVD was identical in black and white subjects. Thus, the observed higher CVD incidence rate in black subjects appears to be largely attributable to a greater prevalence of elevated risk factors. The primary prevention of elevated risk factors might largely eliminate the incidence of CVD, and these beneficial effects would be applicable not only for white but also for black subjects.38
- Data from the Medical Expenditure Panel Survey (MEPS) 2004 Full Year Data File showed that nearly 26 million US adults 18 years of age were told by a doctor that they had HD, stroke, or any other heart-related disease39:
- — 56.6% of those surveyed said they engaged in moderate to vigorous PA 3 times per week; 57.9% of those surveyed who had not been told they had HD engaged in regular PA more than those who had been told they had HD (46.3%).
- — 38.6% maintained a healthy weight. Among those told that they had HD, 33.9% had a healthy weight, as compared with 39.3% who had never been told they had HD.
- — 78.8% do not currently smoke. Among those ever told that they had indicators of HD, 18.3% continued to smoke.
- — More than 93% engaged in at least 1 recommended behavior for prevention of HD: 75.5% engaged in 1 or 2; 18% engaged in all 3; and 6.5% did not engage in any of the recommended behaviors.
-
Age-based variations - – Moderate to vigorous PA 3 times per week varied according to age. Younger people (18 to 44 years) were more likely (59.9%) than those who were older (45 to 64 and 65 years, 55.3% and 48.5%, respectively) to engage in regular PA.
- – A greater percentage of those between 18 and 44 years of age had a healthy weight (43.7%) than did those 45 to 64 years of age and 65 years of age (31.4% and 37.3%, respectively).
- – Those 65 years of age were more likely to be current nonsmokers (89.7%) than were people 18 to 44 years of age and 45 to 64 years of age (76.1% and 77.7%, respectively).
- Race/ethnicity-based variations
- – Non-Hispanic whites were more likely than Hispanics or non-Hispanic blacks to engage in moderate to vigorous PA (58.5% versus 51.4% and 52.5%, respectively)
- – Non-Hispanic whites were more likely to have maintained a healthy weight than were Hispanics or non-Hispanic blacks (39.8% versus 32.1% and 29.7%, respectively)
- – Hispanics were more likely to be nonsmokers (84.2%) than were non-Hispanic whites and non-Hispanic blacks (77.8% and 76.3%, respectively).
- Sex-based variations
- – Men were more likely to have engaged in moderate to vigorous PA 3 times per week than women (60.3% versus 53.1%, respectively).
- – Women were more likely than men to have maintained a healthy weight (45.1% versus 31.7%, respectively).
- – 81.7% of women did not currently smoke, compared with 75.7% of men.
- Variations based on education level
- – A greater percentage of adults with at least some college education engaged in moderate to vigorous PA 3 times per week (60.8%) than did those with a high school education or less than a high school education (55.3% and 48.3%, respectively).
- – A greater percentage of adults with at least some college education had a healthy weight (41.2%) than did those with a high school or less than high school education (36.2% and 36.1%, respectively).
- – There was a greater percentage of nonsmokers among those with a college education (85.5%) than among those with a high school or less than high school education (73.8% and 69.9%, respectively).
- Forty-four percent of participants (18 to 64 years of age at baseline) in the Chicago Heart Association Detection Project in Industry without a history of MI were investigated to determine whether traditional CVD risk factors were similarly associated with CVD mortality in black and white men and women. In general, the magnitude and direction of associations were similar by race. Most traditional risk factors demonstrated similar associations with mortality in black and white adults of the same sex. Small differences were primarily in the strength, not the direction, of association.40
View this table:
[in this window]
[in a new window]
|
Table 2-4. Remaining Risks for CVD and Other Diseases Among Men and Women Free of Disease at 40 and 70 Years of Age
|
|
|
Impact of Healthy Lifestyle and Low Risk Factor Levels
|
|---|
Much of the literature on CVD has focused on factors associated
with increasing risk for CVD and on factors associated with
poorer outcomes in the presence of CVD. However, in recent years,
a number of studies have defined the beneficial effects of healthy
lifestyle factors and lower CVD risk factor burden on CVD outcomes
and longevity. These studies suggest that prevention of risk
factor development at younger ages may be the key to "successful
aging," and they highlight the need for intensive prevention
efforts at younger and middle ages once risk factors develop
to improve healthy longevity.
- The lifetime risk for CVD and median survival were highly associated with risk factor burden at 50 years of age among >7900 men and women from the FHS followed up for 111 000 person-years. In this study, "optimal" risk factor burden at age 50 was defined as BP <120/80 mm Hg, total cholesterol <180 mg/dL, absence of diabetes, and absence of smoking. Elevated risk factors were defined as stage 1 hypertension or borderline high cholesterol (200 to 239 mg/dL). Major risk factors were defined as stage 2 hypertension, elevated cholesterol (240 mg/dL), current smoking, and diabetes. Remaining lifetime risks for atherosclerotic CVD events were only 5.2% in men and 8.2% in women with optimal risk factors at 50 years of age, compared with 68.9% in men and 50.2% in women with 2 major risk factors at age 50. In addition, men and women with optimal risk factors had a median life expectancy 10 years longer than those with 2 major risk factors at age 50.37
- In another study, FHS investigators followed up 2531 men and women who were examined between the ages of 40 and 50 years and observed their overall rates of survival and survival free of CVD to 85 years of age and beyond. Low levels of the major risk factors in middle age predicted overall survival and morbidity-free survival to the age of 85 years or longer.41
- — Overall, 35.7% survived to the age of 85 years, and 22% survived to that age free of major morbidities.
- — Factors associated with survival to the age of 85 years included female sex, lower systolic BP, lower total cholesterol, better glucose tolerance, absence of current smoking, and higher level of education attained. Factors associated with survival to the age of 85 years free of MI, unstable angina, HF, stroke, dementia, and cancer were nearly identical.
- — When adverse levels of 4 of these factors were present in middle age, fewer than 5% of men and approximately 15% of women survived to age 85 years.
- A study of 366 000 men and women from the Multiple Risk Factor Intervention Trial (MRFIT) Study and Chicago cohorts defined low-risk status as follows: serum cholesterol level <200 mg/dL, untreated BP 120/80 mm Hg, absence of current smoking, absence of diabetes, and absence of major electrocardiographic abnormalities. Compared with those who did not have low risk factor burden, those with low risk factor burden had between 73% and 85% lower risk for CVD mortality, 40% to 60% lower total mortality rates, and 6 to 10 years’ greater life expectancy.33
- A study of 84 129 women enrolled in the Nurses’ Health Study identified 5 healthy lifestyle factors, including absence of current smoking, drinking
glass or more of wine per day (or equivalent alcohol consumption), hour or more per day of moderate or vigorous PA, BMI <25 kg/m2, and dietary score in the top 40% (including diets with lower amounts of trans fats, lower glycemic load, higher cereal fiber, higher marine omega-3 fatty acids, higher folate, and higher polyunsaturated to saturated fat ratio). When 3 of the 5 healthy lifestyle factors were present, risk for CHD over a 14-year period was reduced by 57%; when 4 were present, risk was reduced by 66%; and when all 5 factors were present, risk was reduced by 83%.42
- Among individuals 70 to 90 years of age, adherence to a Mediterranean-style diet and greater PA are associated with 65% to 73% lower rates of all-cause mortality, as well as lower mortality rates due to CHD, CVD, and cancer.43
- Seventeen-year mortality data from the NHANES II Mortality Follow-Up Study indicated that the risk for fatal CHD was 51% lower for men and 71% lower for women with none of 3 major risk factors (hypertension, current smoking, and elevated total cholesterol [240 mg/dL]) than for those with 1 or more risk factors. Had all 3 major risk factors not occurred, it is estimated that 64% of all CHD deaths among women and 45% of CHD deaths in men could have been avoided.44
- Investigators from the Chicago Heart Association Detection Project in Industry have also observed that risk factor burden in middle age is associated with better quality of life at follow-up in older age (approximately 25 years later) and lower average annual Medicare costs at older ages.
- — The presence of a greater number of risk factors in middle age is associated with lower scores at older ages on assessment of social functioning, mental health, walking, and health perception in women, with similar findings in men.45
- — Similarly, the existence of a greater number of risk factors in middle age is associated with higher average annual CVD-related and total Medicare costs (once Medicare eligibility is attained).46
|
Hospital Discharges, Ambulatory Care Visits, and Nursing Home Visits
|
|---|
- From 1979 to 2005, the number of inpatient discharges from short-stay hospitals with CVD as the first-listed diagnosis increased 26% to 6 159 000 discharges (NCHS, NHDS). In 2005, CVD ranked highest among all disease categories in hospital discharges.47
- In 2005, there were 81 836 000 physician office visits with a primary diagnosis of CVD (NCHS, NAMCS).48
- In 2005, there were 4 036 000 visits to EDs with a primary diagnosis of CVD (NCHS, NHAMCS).49
- In 1999, 23% of nursing home residents 65 years of age had a primary diagnosis of CVD at admission. This was the highest disease category for these residents (NCHS, NNHS).50
- In 2005, there were 6 734 000 outpatient department visits with a primary diagnosis of CVD (NHAMCS).51 In 2005, approximately 1 of every 6 hospital stays, or almost 6 million, resulted from CVD. The total inpatient hospital cost for CVD was $71.2 billion, approximately one fourth of the total cost of hospital care in the United States. The average cost per hospitalization was approximately 41% higher than the average cost for all stays. Hospital admissions that originated in the ED accounted for 60.7% of all hospital stays for CVD. This was 41% higher than the overall rate of 43.1%; 3.3% of patients admitted to the hospital for CVD died in the hospital, which was significantly higher than the average in-hospital death rate of 2.1%.52
- Coronary atherosclerosis involved 1.2 million hospital stays and was the most expensive condition treated. This condition resulted in >$44 billion in expenses. More than half of the hospital stays for coronary atherosclerosis were among patients who also received percutaneous coronary intervention or cardiac revascularization (coronary artery bypass graft [CABG]) during their stay. Acute MI resulted in $31 billion of hospital charges for 695 000 hospital stays. The 1.1 million hospitalizations for CHF amounted to nearly $29 billion in hospital charges.53
- In 2003, approximately 48.3% of hospital stays for CVD were for women, who accounted for 42.8% of the national cost ($187 billion) associated with these conditions. Although only 40% of hospital stays for acute MI and coronary atherosclerosis were for women, more than half of all stays for nonspecific chest pain, congestive HF, and stroke were for women. There was no difference between men and women in hospitalizations for cardiac dysrhythmias.54
- Circulatory disorders were the most frequent reason for admission to the hospital through the ED, accounting for 26.3% of all admissions through the ED. After pneumonia, which was ranked first, the most common heart-related conditions were CHF (2), chest pain (3), hardening of the arteries (4), and heart attack (5), which together accounted for >15% of all admissions through the ED. Stroke and irregular heart beat ranked seventh and eighth, respectively.55
|
Cost
|
|---|
- The estimated direct and indirect cost of CVD for 2008 is $448.5 billion.
- In 2003, $31.7 billion in program payments were made to Medicare beneficiaries discharged from short-stay hospitals with a principal diagnosis of CVD. That was an average of $8966 per discharge.56
- A study of the 1987 National Medicaid Expenditure Survey and the 2000 MEPS, Household Component, showed the 15 most costly medical conditions and the estimated percentage increase in total healthcare spending for each condition from 1987 to 2000. The following are some of the top 15 conditions, in rank order, and their percentage impact on healthcare spending: heart disease (1), +8.06%; cancer (4), +5.36%; hypertension (5), +4.24%; cerebrovascular disease (7), +3.52%; diabetes (9), +2.37%; and kidney disease (15), +1.03%.57
|
Operations and Procedures
|
|---|
- In 2005, an estimated 6 989 000 inpatient cardiovascular operations and procedures were performed in the United States; 4.1 million were performed on males, and 2.9 million were performed on females (NHDS, NCHS).47
|
References
|
|---|
Top
Table of Contents
Disease Prevalence
