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The High Cost of Congestive Heart Failure

Doctor examines elderly man's heart

Congestive heart failure (CHF) doesn’t receive the same attention that cancer does, but it’s a major chronic illness in the U.S., affecting more than five million patients. CHF refers to a condition where the heart cannot pump enough blood to meet the body’s needs.

According to government statistics, about 550,000 new cases are diagnosed annually, resulting in an estimated $35 billion per year in healthcare costs. Indirect costs to society from disability benefits and lost wages are estimated to be even higher.

To illustrate the costs of this epidemic in human terms, let me share my experience with a patient whom I’ll call Eric.

I first met Eric in late 2011. He was an easygoing retired professional in his early 70s, enjoying an active lifestyle. His concerned wife brought him to see me after he was hospitalized for heart failure.

His history was well documented. Eric had suffered a heart attack in 2001 caused by acute obstruction of his left anterior coronary artery. He had called 911 and was taken to the nearest hospital after feeling heaviness in his chest and abdomen for several hours. There, an emergency cardiac catheterization was performed. Doctors successfully opened his occluded artery but explained that he had experienced substantial heart damage. He recovered and was discharged from the hospital five days later.

Medications were then used to control his elevated blood pressure and cholesterol. Eric never experienced another heart attack. But in the summer of 2011, he began to notice shortness of breath when walking up a hill or carrying his golf bag, and gradually started to curtail his physical activities. In October of the same year he was rushed to the emergency room with severe respiratory distress after contracting a cold. There, he learned he had congestive heart failure. Symptoms improved after he received intravenous diuretics.

Half of all CHF cases occur in patients like Eric who have survived a previous heart attack. While improved treatment using cholesterol-lowering drugs, anticoagulants and coronary stents has increased the number of patients who survive an initial episode, many who experience a reduction in cardiac function go on to develop heart failure. The other CHF cases involve patients with various other cardiac conditions affecting the heart muscle, such as uncontrolled high blood pressure, diabetes or rare viral infections.

Regardless of the cause of the condition, a study has shown that patients with CHF have poor five-year survival rates, similar to those of people with the most common forms of cancer. Moreover, quality of life is substantially decreased, and 20 percent of patients who are discharged from the hospital with the diagnosis of heart failure need to be readmitted within 30 days.

With this in mind, I started Eric on the standard heart-failure medications that have been shown to improve survival and quality of life: ACE inhibitors, beta blockers and diuretics. I also implanted a defibrillator to detect and treat potentially fatal heart-rhythm abnormalities common in heart-failure patients, which can cause sudden cardiac death. He did well for several months, as I monitored him closely while increasing his medications.

Eventually, however, his heart became too weak, and we were faced with stark options: let him die, implant a mechanical left ventricular assist device or offer him a heart transplant.

The last option seemed ideal, since at the best transplant centers in the U.S., such as Montefiore Medical Center, where I practice, survival rates after heart transplants exceed 85 percent. Unfortunately, only about 2,500 heart transplants are done each year in our country. The number has been flat for almost 10 years.

Eric’s otherwise excellent state of health qualified him for a transplant. After waiting four weeks in our coronary care unit while receiving intravenous drugs to keep his heart working, he received the heart of a 44-year-old woman who had died in a motor vehicle accident. He’s currently recovering and although he’ll need to undergo an intense program of surveillance and treatment to prevent organ rejection, he has a new lease on life.

Sadly, Eric is an exception, not the rule. The low number and high cost of transplants— several million dollars in hospital charges and medications to prevent organ rejection—mean that only one in 200 heart-failure patients will benefit from transplantation.

We need better options. I’m hopeful that researchers will find new treatments for CHF based on stem cell therapy or discover new drugs that help regenerate a patient’s cardiac muscle. One day, I hope to treat patients like Eric with these less invasive and less destructive practices, giving them the improved outlook and quality of life they deserve.

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Mario J. Garcia, M.D.

Mario J. Garcia, M.D.

Mario J. Garcia, M.D. is co-director, Montefiore Einstein Center for Heart and Vascular Care and chief, Division of Cardiology, Albert Einstein College of Medicine and Montefiore Medical Center. He is also Pauline Levitt Chair in Medicine at Albert Einstein College of Medicine.

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