Congestive Heart Failure Cases Rise, Experts Say
Despite a 24.5% drop in deaths from all heart disease between 1982 and 1992, the incidence of congestive heart failure more than doubled during the same period, according to the American Heart Assn.
The congestive disease, in which the heart muscle is overworked or damaged and unable to pump out all the blood that returns to it, accounted for 822,000 hospitalizations in the United States in 1992 and 39,000 deaths, the association disclosed at a science writers’ seminar here.
Ironically, the disease is on the rise because heart attack victims get better treatment and live long enough to develop it. Success in treating heart problems has generated criticism because congestive heart failure “is the No. 1 economic drain on Medicare,” one expert said.
More than 3 million Americans suffer from the disorder.
It is “the only cardiovascular disease that is increasing in frequency and incidence,” said Dr. Maria Rosa Costanzo of Rush-Presbyterian-St. Luke’s Medical Center in Chicago.
“Its incidence is associated with aging, and it is increasing because of the many avenues we now have to improve the outcomes of people with . . . heart disease.” In other words, drugs and other treatments that keep people alive after heart attacks allow them to live long enough to develop congestive heart disease.
Despite the continuing decline in deaths from heart disease as well as stroke, together they remain the nation’s No. 1 killer, accounting for 42.5% of all deaths, about 925,079 in 1992.
If all deaths from heart disease could be eliminated, according to the heart association, the average life span in the nation would be extended 9.78 years.
But if all types of cancer were eliminated, the increased life expectancy would be less than three years.
Congestive heart failure is characterized by shortness of breath, inability to carry out physical tasks and a general lack of energy. Most treatments only alleviate symptoms. The only cure is a heart transplant.
The ultimate cause of the increase in congestive heart failure is the array of new treatments for heart attacks, including the so-called clot busters that open arteries blocked by clots, as well as angioplasty to widen arteries blocked by atherosclerosis, aspirin to forestall repeat heart attacks, and beta blockers that improve heart function after attacks.
“People are living longer after a heart attack, with a better quality of life,” said Dr. Suzanne Oparil of the University of Alabama, president of the heart association.
“Only 10 years ago, virtually everybody who had a heart attack died within five years. Now, with appropriate treatment, the majority live longer than five years, but that places them at greater risk of developing congestive heart failure.”
Ironically, the heart association and cardiologists have been the targets of some criticism about the increased life span of heart patients because of the economic impact.
“Heart failure is the No. 1 economic drain on Medicare” because 85% of people with the illness are over 65, said Dr. John B. O’Connell of the University of Mississippi at Jackson. With hospitalization, outpatient visits and related medical costs, congestive heart disease costs the American health care system about $40 billion a year, he said. That is nearly a third of the total bill for all forms of cardiovascular disease, according to the association--$128 billion in 1994.
Despite the gains in fighting heart disease, much remains to be done, Oparil said. Studies have shown that 70% of Americans have risk factors that predispose them to the development of heart disease, but the vast majority do little to reduce those risks.
Only 21% of people with high blood pressure, for example, have brought it under control with diet or drugs. Theoretically, 95% of them should be able to control hypertension. Among the major obstacles are the cost of the drugs and the patients’ unwillingness to put up with adverse side effects, such as impotence.
Very few people with high cholesterol levels are taking cholesterol-lowering agents, Oparil said. Fewer people are stopping smoking, and young white women are taking up smoking at an even higher rate. A sedentary lifestyle has become a distinct risk factor, she added, and the proportion of obesity in the population has increased from 25% to 33% in 10 years.
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