The U.S. and other countries have made dramatic progress in lowering mortality from cardiovascular diseases, which include heart disease and stroke. In the U.S., the mortality rate has fallen from 590 deaths per 100,000 people in 1983 to 253 in 2013. Recently, this has been due in large part to improvements in emergency response for heart attack patients, in addition to medical advances, reduced smoking rates, and improvements in controlling cholesterol and blood pressure. This chart collection explores prevalence, spending, and health outcomes for cardiovascular disease and related conditions.
Heart disease refers to heart ailments such as heart attack, arrhythmia, and heart valve problems, and is included in a more broad set of cardiovascular diseases, such as stroke and acute rheumatic fever. The U.S. has seen significant improvements in both mortality and disease burden due to heart disease over the past few decades, as well as more recent improvement in some indicators of quality of care for heart disease. Heart disease has long been the leading cause of death in the U.S. and currently remains so, accounting for 23.4% of all deaths in 2014 - only slightly more than malignant neoplasms (cancer), which accounted for 22.5% of all deaths. Stroke is the fifth leading cause of death, accounting for 5.1% of all deaths in 2014.
All racial/ethnic groups in the U.S. have had a similar decline in mortality due to cardiovascular disease. However, mortality for blacks has remained high, dropping from 452 deaths per 100,000 people in 1999 to 283 in 2014, compared to the the total population's mortality decline from 352 deaths per 100,000 people to 221. Cardiovascular disease mortality is lowest among Asians and Pacific Islanders.
Aside from mortality and prevalence, another way to measure the effect cardiovascular disease has on health is to look at the burden of disease, which takes into account both years of life lost due to premature death as well as years of productive life lost to poor health or disability. According to data from the Institute for Health Metrics and Evaluation, cardiovascular diseases are the second leading cause of disease burden in the U.S, resulting in 3,261 DALYs per 100,000 population in 2013, a 36% improvement from 1990.
For a given population, DALYs are calculated by summing the Years of Life Lost (YLL) prematurely and the Years Lived with Disability (YLD, which are weighted). For each of the disease categories with improvements in age-standardized DALYs, the improvement has come primarily from a reduction in the years of life lost (as opposed to a reduction in the year lived with disability).
The U.S. has also seen improvement in the contribution of leading risk factors to disease burden for cardiovascular diseases. Smoking, hypertension, high blood cholesterol, physical inactivity, high body-mass index, and high blood sugar levels are all leading risk factors for heart disease and stroke, and instances of cardiovascular disease are often attributable to more than one of these factors. When we look at cardiovascular diseases by known linked risk factors, we find that high systolic blood pressure is the primary contributor to disability adjusted life years (DALYs) for cardiovascular disease, followed by high body-mass index, high total cholesterol, and smoking. From 1990 to 2013, disease burden decreased significantly for cardiovascular diseases attributable to the risk factors shown above.
The prevalence of heart disease and stroke among adults in the U.S. remained about the same from 2004 to 2014. The prevalence of hypertension (high blood pressure, a major risk factor for heart disease and stroke) has risen slightly from 22% in 2004 to 25% in 2014.
The prevalences of heart disease, stroke, and hypertension among adults in the U.S. drop slightly as family income increases. Thirteen percent of adults in families with a yearly income below $35,000 experience heart disease, compared to 10% of adults in families with an income of $75,000 or more. Four percent of adults in families with an income below $35,000 experience stroke, while 2% of those in families with an income of $75,000 or more do so. This disparity is more marked for the prevalence of hypertension among adults: hypertension affects 29% of adults in families with an annual income below $35,000, compared to 21% of adults in families with an income of $100,000 or more per year.
National Health Interview Survey data indicate a slight drop in the prevalence of heart disease among adults as their education level increases. People with less than a high school diploma are slightly more likely to have heart disease or stroke than the average U.S. adult. There is a more marked difference in the prevalence of hypertension based on education level: only those with at least a bachelor’s degree experience a below average prevalence of hypertension (22% compared to the average of 25%).
Hospital admissions for congestive heart failure are more frequent in the U.S. than in most comparable countries
Hospital admissions for certain chronic conditions like hypertension (high blood pressure) can arise when prevention services are either not being delivered or not adhered to by patients. Hospital admission rates in the U.S. are higher than in comparable countries for congestive heart failure (which is often caused by unmanaged hypertension). However, the U.S. has lower rates of hospitalization for hypertension than comparably wealthy countries do on average, due to much higher rates of hospital admission for hypertension in Germany and Austria.
Receiving evidence-based treatment upon presentation of a heart attack can minimize mortality. Between 2005 and 2012, hospital patients with a heart attack increasingly received percutaneous coronary intervention (angioplasty) within 90 minutes of arrival and fibrinolytic medication (drugs that dissolve blood clots) within 30 minutes of arrival.
Since 2005, an increasing percentage of patients who experienced heart failure and left ventricular systolic dysfunction have been discharged with a prescription for an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker.
Mortality within 30 days of being admitted to a hospital is not entirely preventable, but can be reduced for certain diagnoses and services. Improvement in this area is often linked to improved quality of care. From 2010 to 2013, among admitted Medicare fee-for-service patients age 65 and older, 30-day mortality rates improved slightly for heart attacks (acute myocardial infarction) and ischemic strokes (caused by blood clots), but did not improve for heart failure.
The 30-day mortality rates for heart attacks (acute myocardial infarction) and ischemic strokes (caused by blood clots) are lower in the United States than in comparable countries. The 30-day mortality rate for hemorrhagic stroke (caused by bleeding) is similar in the U.S. and comparable countries.
Spending on circulatory system diseases accounts for about 13% of disease based health expenditures
In 2012, spending on circulatory system diseases accounted for 13% of medical services spending on disease treatment ($241 billion of the $1.9 trillion total). The top five disease-based spending categories (ill-defined conditions, circulatory, musculoskeletal, respiratory, endocrine, and nervous system conditions) account for roughly half (51%) of all medical services spending by disease category.
Circulatory system diseases accounted for 8.6% of medical services spending growth from 2000 – 2012. Treatments for ill-defined conditions, musculoskeletal disorders (which include back problems and arthritis) and circulatory diseases were the three largest contributors to overall health services spending growth over the 2000 – 2012 period.
Health care spending has grown slowly in recent years across the board (due at least in part to the sluggish economy), and circulatory system diseases in particular have seen persistently slow growth, even after the Great Recession. Spending on the treatment of all diseases rebounded slightly post-recession (growing 3.9% on average from 2010-2012, up from 3.7% during the 2008-2010 recessionary period). By contrast, spending growth for circulatory conditions continued to fall post-recession, to an average of 0.3% annual growth from 2010 – 2012, down from 1.5% annually in the previous three year period.
In 2012, per capita spending on circulatory system diseases in the U.S. was $767, up from $554 per capita in 2000.
People with a current or prior diagnosis of heart disease, stroke, high blood pressure, or high cholesterol have higher spending on average than people without a diagnosis.
People with a current or prior diagnosis of heart disease, stroke, high cholesterol, or high blood pressure face higher average out-of-pocket costs than people without a diagnosis.