Heart disease is the biggest killer in the United States, western Europe, and many other parts of the world¹.  More than cancer, HIV/AIDS, and accidents, heart disease steals away people’s productivity and people’s lives.

Heart disease is also expensive to treat.  Catheterization laboratories, surgical operations, newfangled drugs, stents and other gadgets, cost US insurance companies and taxpayers hundreds of billions of dollars each year.  But despite all the money spent, Americans die of heart disease more frequently than of any other cause.  How are we spending our health care dollars on heart disease, and what are we getting for our pains?  How good of a job are we doing in treating heart ailments?  Are we winning?

To answer these questions, it is necessary to understand what we mean by heart disease.  Very broadly, most heart disease falls into main categories:  acute heart attacks (or myocardial infarctions), and more chronic heart failure, which is an inability of the heart to pump sufficiently.  Heart attacks are sudden, and can result in death before a patient even arrives at the hospital.  If a patient does reach the hospital, then swift and immediate action is often required to save that patient’s life.  In contrast, heart failure is a chronic disease that lasts for years and can develop after a patient has survived a heart attack.  Treatment of heart failure involves medications and lifestyle changes, and requires excellent care from physicians over long time periods.

If you suffer a heart attack in the United States and you make it to the hospital, then recent statistics say that your chance of dying from that heart attack is about 12% ².  Five years after a heart attack, your total chance of dying from heart disease is about 37% ³.  These numbers are grim, but they actually compare pretty well to statistics from western European countries.  In fact, in the United Kingdom, your chance of dying from a heart attack after you arrive at the hospital is about 25% ⁴.  This is double the chance of dying from a heart attack in the US.  After 5 years, the mortality in the UK is about 43% ⁵, which is more comparable to US mortality, but still higher.  What is clear from these numbers is that heart attack patients who make it to a US hospital are only half as likely to die as those who are admitted to a UK hospital.  The reasons for the improved survival in the US are likely the wider availability of cardiologists, and access to catheterization labs and to advanced medicines and stents. 

If a patient is lucky enough to survive a heart attack, what happens if heart failure set in afterwards?  Here again, the numbers are startling.  In the US, mortality in the first year after diagnosis of heart failure is about 20% ³.  However, mortality in the UK is twice this number:  almost 40% of heart failure patients die in the first year ⁶.  So, for both acute heart attack and for chronic heart failure, the American health care system cuts death rates in half as compared to western European countries like the UK.   

The US spends a much-maligned 16% of GDP on healthcare.  This is substantially higher than the 11% spent by the UK.  In both countries, a substantial chunk of this health care money goes to treating heart disease.  In the US, our increased investment in catheterization laboratories and advanced therapies has clearly translated into saving hundreds of thousands of lives.  Similar to the survival from cancer, survival from heart disease is much better in the US than in the UK.  This is no accident – our commitment to and investment in health care mean that Americans are much more likely to survive life’s vicissitudes, such as heart disease and cancer, than our European counterparts.   

References:

1. European Cardiovascular Disease Statistics
2. New England Journal of Medicine 2007; 356: 1099-1109
3. American Heart Association 2009 Statistics
4. BMC Cardiovascular Disorders 2004; 4:14.
5. British Regional Heart Study
6. London Heart Failure Study