Risk Factors, Comorbidities, and Costs of Heart Failure

Brian Martin, PhD

In a previous article, heart failure (HF) and other cardiovascular diseases, were introduced as major contributors to mortality each year in the US. Heart failure occurs when the heart can no longer meet the demands of the rest of the body, and is often associated with, and occurs alongside, other cardiovascular diseases such as coronary heart disease, heart attack, hypertension, overweight, obesity and diabetes.

Of the predominating risk factors or comorbidities that occur alongside HF, hypertension appears to be the most prevalent, followed by coronary heart disease and stroke.

Importantly, it appears that certain conditions can worsen comorbidities, such as overweight and obesity increasing the risk of developing hypertension, thus increasing risk of HF. Further, comorbidities such as hypertension progress in such a way to induce HF.

This occurs as increased pressure requires extra effort by the heart to pump blood to the body, resulting in compensatory hypertrophy and dilated cardiac chambers that can no longer relax or contract effectively, resulting in HF. Similarly, coronary heart disease can result in myocardial infarction, damaging the heart and killing cardiomyocytes, which cannot regenerate, resulting in scarring and replacement fibrosis, leading again to reduced ability of the heart to relax or contract, ultimately leading to HF.

These insights indicate that preventative measures are needed early on to halt the progression of risk factors to full on cardiovascular disease leading to HF. As such, for certain HF conditions (e.g. HF with preserved ejection fraction, or HFpEF), it has been suggested that the best way to treat the condition is to focus treatment on comorbidities, as no effective therapy exists for HFpEF.

In many patients with HFpEF, non-cardiovascular related deaths are often more common that HF deaths, and thus treatment of comorbidities including smoking, diabetes and pulmonary diseases, should be used as therapy.

As mentioned above, hypertension is a common comorbidity of, and primary driver for, HF development, and thus provides one avenue of early treatment for HF prevention. In sum, treatment of conditions which progress to HF exhibit compelling starting points for HF prevention.

At least as early at 2011, researchers have predicted increased HF and cardiovascular disease occurrence and rising health care costs associated with cardiovascular diseases, estimating that at least 40% of Americans will suffer from some form of cardiovascular disease by the year 2030. The total, direct medical costs of cardiovascular diseases is expected to increase by 200% to $818 billion dollars, while indirect costs (those associated with missed labor, etc.) are expected to rise by 61% to $275 billion dollars.

A primary cause of increased costs associated with cardiovascular disease is an aging population, which marks an improvement in patient survival and longevity, even if those extra years alive are not disease free. An increase in longevity but not health may be partly explained by a healthcare system designed to treat symptoms of HF as they present, and not treating underlying causes of the disease, thus prolonging life, but not curing the disease.

Further, a large and rapid increase of diabetes, overweight and obesity in the population is thought to contribute to rising cardiovascular disease occurrence and costs, which may increase medical costs more than predicted.

Considering these dramatic predicted increases in cardiovascular disease and associated diseases including hypertension, diabetes, overweight and obesity, and increasing medical costs and lost labor, the next article will discuss preventative measures to aid in reduction of cardiovascular diseases among those at high risk, both young and aged.

Brian Martin is a post-doctoral research fellow at Baylor College of Medicine studying heart failure and atrial fibrillation. The opinions expressed in the piece here are solely those of the author, and do not reflect those of the publication.

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