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Cape 1 Lea Anne Cape Dr. Guenzel ENC 1102-0123 March 31, 2014 Technology and Cardiovascular Disease Most people know that medical treatments are pricey, but are the cost worth the benefits that the treatment provides? Cardiovascular disease treatments are one of the medical procedures that are considered expensive. “About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths [making this the leading cause of death]” ("Heart Disease Facts." 1). “Cardiovascular disease also called heart disease — includes numerous problems, many of which are related to a process called atherosclerosis. Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke.” ("What Is Cardiovascular Disease (Heart Disease)?” 1). Every minute one person dies of a heart attack (Maier 1). Every 40 seconds someone has a stroke (The Internet Stroke Center 1). Imagine this, Millie a 65-year-old woman off to Iowa to visit with her daughter starts to feel a crushing feeling in her chest as well as shortness of breath. Her doctor gives her the choice of receiving angioplasty – a procedure to help open the narrowed vessels ("Millie's Story" 1). What symptoms could she have recognized early on? Should she go through with the surgery? What are her other options? Is there a risk? Cape 2 Had Millie been educated she might have realized that she was at risk of having cardiovascular disease and took steps to help with prevention. Stutter Health says that the major indicators of Cardiovascular Disease are blood pressure in the prehypertensive classification (blood pressure falling between 120/80 and 130/89), a total cholesterol that is above 200 milligrams per deciliter, and excess weight. “Excess weight taxes your heart, raises blood pressure, cholesterol and triglyceride [the main constituents of natural fats and oils] levels while lowering good cholesterol levels.” (Stutter Health). These are measured and kept an eye on by a physician. However, they may neglect to tell you so it is your responsibility to keep track of the information. With this information what could Millie have done for prevention? According to Stutter Health, Cholesterol (HDL [good cholesterol], LDL [bad cholesterol] and triglyceride levels), blood pressure, BMI [body mass index], and blood sugar can be watched in order to prevent or lessen the effects of Cardiovascular Disease. There are many inexpensive options to help a patient watch these symptoms such as “Eating a healthy, balanced diet, limiting alcohol, not smoking, undertaking regular physical exercise…maintaining a healthy body weight, maintaining healthy blood cholesterol levels, [and] effectively treating medical conditions such as diabetes and high blood pressure” (Southern Cross). However, Millie did not recognize her risk early on and acquired the disease. What are her different treatment options? Depending on test results, various treatment options will be considered. Treatment may include medication, coronary angioplasty (with or without coronary artery stenting), or coronary artery bypass graft surgery (sometimes abbreviated to CABG). According to WebMD, the most common medication that could be prescribed to Millie includes ACE Inhibitors, Aldosterone Inhibitor, Angiotensin II Receptor Blocker (ARBs), Beta-Blockers, Calcium Channel Blockers, Cholesterol -Lowering Drugs, and Digoxin. The first option is an Cape 3 ACE Inhibitors which will “dilate (widen) arteries to lower blood pressure and make it easier for the heart to pump blood” (WebMD). The second option, an Aldosterone Inhibitor, is “prescribed to reduce the swelling and water build-up caused by heart failure” (WebMD). The third option or “ARBs are used to decrease blood pressure in people with heart failure…[by helping to] decrease certain chemicals that narrow the blood vessels so blood can flow more easily through your body…[and by] decrease[ing] certain chemicals that cause salt and fluid build-up in the body” (WebMD). Millie’s fourth option are Beta-blockers which block the effects of adrenaline (epinephrine) which can improve the heart's ability to perform…[and] decrease the production of harmful substances produced by the body in response to heart failure” (WebMD). The fifth option is Calcium Channel Blockers which “treat angina (chest pain) and high blood pressure” (WebMD). Her sixth option is Cholesterol -Lowering Drugs. These limit the amount of cholesterol deposits that build up in the arteries blocking off oxygen (WebMD). Her last medicinal option, Digoxin, “strengthens the force of the heart muscle's contractions and may improve blood circulation” (WebMD). The “average monthly medication costs are $104.77 for cardiac medications”, which is approximately $1257.24 a year (Patricoski). Millie’s surgery options are coronary angioplasty (with or without coronary artery stenting), or coronary artery bypass graft surgery (sometimes abbreviated to CABG). Coronary angioplasty is “used to open clogged heart arteries… [by] temporarily inserting and inflating a tiny balloon where your artery is clogged to help widen the artery”(MayoClinic). Sometimes a stent is placed into the artery to ensure that the blood vessel does not narrow again and some of the stents “are coated with medication to help keep your artery open” (MayoClinic). CABG is an open surgery (meaning that the patient’s chest is open) where the portion of a clogged artery is bypassed using pieces of veins, that can be taken from their leg or arteries in the chest, to return Cape 4 the flow of blood and oxygen (John Hopkins). “The average bypass-procedure cost was $20,673 in the U.S” (Barry). ”[All these] treatment[s]…[are] aimed at reducing or eliminating symptoms and reducing the risk of having a heart attack.” (Southern Cross). However, there are many disadvantages of the technology (markers, prevention, and treatment). The most commonly complained about disadvantage is cost. “A person with heart disease is burdened by huge expenses, including diagnostic tests, surgery, hospital and doctors’ visits, physical therapy, and costly drugs. A conservative estimate of these costs for just one person is $121,200 over 20 years” ("The Cost of Heart Disease and Stroke: The Economic Impact of Heart Disease and Stroke in the United States" 2). “In 2010, the total costs of cardiovascular disease in the United States were estimated to be $444 billion. Treatment of these diseases accounts for about $1 of every $6 spent on health care in this country.” (“Heart Disease and Stroke Prevention.”). In 2009, 9.6 billion dollars was spent on hospital bills alone and 3.4 billion dollars was spent on medications ("Economic Costs."). Surgery costs vary “increasing [in] complexity of the operation from a median of $12,761 for atrial septal defect repair to a median of $55,430 for the arterial switch operation” ("Costs of Congenital Heart Operations Vary among Hospitals."). “Surgery or procedures and ongoing care, the cost can be more than $4.8 million over a lifetime” ("The Cost of Heart Disease and Stroke: The Economic Impact of Heart Disease and Stroke in the United States” 2). There are also risk factors that come with surgery. “The catheter insertion site could become infected or bleed heavily and will likely be bruised” if angioplasty with stenting is used (“Benefits and Risks – Stenting”). “Potential complications of CABG include bleeding or infection, stroke (which is primarily related to age and history of previous stroke), kidney failure (related in large measure to the kidney function before the surgery), and heart attack during or after the surgery” (Sundt). Also, just because a Cape 5 marker tells you that you are at risk, doesn’t mean you are going to have cardiovascular disease. The markers can give false information depending on what method was used during the testing, such as blood testing. This is considered a disadvantage of having the technology. However, cardiovascular disease research is still in progress and though the theory works for the majority of patients there is always a more effective method waiting to be discovered. However, according to David Cutler, Mark McClellan, and Joseph Newhouse, the authors of The Costs and Benefits of Intensive Treatment for Cardiovascular Disease, when comparing the costs and disadvantages to the advantages of treatment and markers, the treatment and markers is the least expensive. They describe the costs and the benefits for medical care to patients with cardiovascular disease. They analyze the costs of cardiovascular disease over many years and they remember to take out the inflation to make an accurate comparison. This is then compared to the benefits which are given an estimated price value. When the ratio of cost to benefit is compared the thesis is that “the value of improved health care is greater than the increased cost of heart attack care” (Cutler 3). When they searched for a value of life in dollars, they tell us that it is very controversial. This is because Viscusi estimates that life per year is worth $25,000, but others estimate much higher, such as Tolley, who estimates the price of one year of life to be somewhere between $75,000 to $150,000 (Cutler 27). Cutler and his team go with the lowest cost of life to make it fair when comparing it to the prices of care for cardiovascular disease treatment. Had they used the higher dollar amount when comparing prices, it would have made the argument biased because treatment would never exceed the price of life. They utilize visual stimuli to help convince the audience that they are correct. Their choice of visual stimuli is a table using this price of life compared to the price of care for a heart attack and it shows that it would only cost $4000 to treat a person rather than the $15,000 it takes Cape 6 to sustain a life one year. “In other words, we are better off for having spent our money on heart attack care than we would have been if the money would have been spent elsewhere” (Cutler 28). Does the value of the benefits that a treatment provides exceed the cost of medical treatment? Based on the research conducted along with the numerous other sources from above, it seems that the benefits do in fact overcome the expensive prices of care. All patients including Millie will benefit from treatment. Whether you look at the situation of a cardiovascular patient at an emotional stand point or a monetary stand point the result is always the same: receiving treatment will triumph going without care. Cape 7 Works Cited Barry, Theresa, and Kristen Hallam. "Heart Surgery Costs 83% More in U.S. Than in Canada, Study Says." Bloomberg.com. Bloomberg, 11 July 2005. Web. 05 Apr. 2014. "Costs of Congenital Heart Operations Vary among Hospitals." AHRQ.gov. N.p., Mar. 2012. Web. 29 Mar. 2014. Cross, Southern. "Coronary Heart Disease - Causes, Symptoms, Prevention." Coronary Heart Disease - Causes, Symptoms, Prevention. Southern Cross Healthcare Group, 26 June 2013. Web. 24 Mar. 2014. Cutler, David, Mark McClellan, and Joesph Newhouse. "The Costs and Benefits of Intensive Treatment for Cardiovascular Disease." National Bureau of Economic Research 6514 (1988): 1-51. Web. 13 Mar. 2014. "Economic Costs." British Heart Foundation. N.p., n.d. Web. 29 Mar. 2014. Harvard Kennedy School. "Joseph Newhouse." Hks.harvard. The President and Fellows of Harvard College, 2014. Web. 18 Mar. 2014. Health, Stutter. "Heart Disease Risk Factors." MyLifeStages: Health and Wellness. Stutter Health, n.d. Web. 23 Mar. 2014. "Heart Disease Facts." Cdc. Centers for Disease Control and Prevention, 28 Aug. 2013. Web. 17 Mar. 2014. Heart Disease and Stroke Prevention." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 21 July 2010. Web. 24 Mar. 2014. Cape 8 John Hopkins. "Coronary Artery Bypass Graft Surgery (CABG)." Johns Hopkins Medicine, Based in Baltimore, Maryland. John Hopkins University, n.d. Web. 29 Mar. 2014. Maier, Rachael. "Heart Disease Statistics." Healthline. Healthline Networks, Inc., 28 Feb. 2014. Web. 18 Mar. 2014. "Mark B. McClellan, M.D., Ph.D." About FDA. U.S. Food and Drug Administration, 04 Jan. 2009. Web. 18 Mar. 2014. MayoClinic. "Coronary Angioplasty and Stents." Definition. N.p., n.d. Web. 29 Mar. 2014. "Millie's Story." Coronary Artery Disease. Medtronic, Inc, 22 Sept. 2010. Web. 18 Mar. 2014. Patricoski, CT, and G. Steiner. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, May-June 1999. Web. 05 Apr. 2014. "The Cost of Heart Disease and Stroke: The Economic Impact of Heart Disease and Stroke in the United States." Orau.gov. N.p., n.d. Web. "The Internet Stroke Center." Stroke Center. The Internet Stroke Center, 2014. Web. 18 Mar. 2014. University, Harvard. "David M. Cutler." Scholar.Harvard. The President and Fellows of Harvard College, n.d. Web. 13 Mar. 2014. WebMD. "Common Heart Disease Drugs and Medications." WebMD. WebMD, n.d. Web. 29 Mar. 2014. "What Is Cardiovascular Disease (Heart Disease)?" Heart.org. The American Heart Association, 28 Dec. 2011. Web. 17 Mar. 2014.