Download research paper draft 2 - ENC 1102 E

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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?
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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
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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
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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
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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
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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.
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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.
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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
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"Heart Disease Facts." Cdc. Centers for Disease Control and Prevention, 28 Aug. 2013. Web. 17
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Heart Disease and Stroke Prevention." Centers for Disease Control and Prevention. Centers for
Disease Control and Prevention, 21 July 2010. Web. 24 Mar. 2014.
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John Hopkins. "Coronary Artery Bypass Graft Surgery (CABG)." Johns Hopkins Medicine,
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Maier, Rachael. "Heart Disease Statistics." Healthline. Healthline Networks, Inc., 28 Feb. 2014.
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