The Impact of Hypertension
Employment:
Besides causing considerable difficulties for patients and affecting quality of life, heart disease and stroke have a significant economic cost. Not only do heart disease and stroke affect the health system, they also affect the overall economy through missed work and lower productivity.
In her 1998 paper "Living with Heart Disease - The working age population." Helen Johansen states that "it seems likely that the employment and income situation of people with heart disease may be influenced by their poor health."
Johansen writes that 35 to 64 is a prime age range for labour force participation, just 48% of men with heart disease reported that they were working for pay or profit
Men without heart disease were much higher at 83%. The corresponding rates among women were 36% and 64%. For both sexes, the age-adjusted odds that those with heart disease would be employed were less than half those for people without heart disease
In addition, 43% of the men with heart disease worked 30 or more hours a week, well below the figure for men who had not been diagnosed with a heart condition (79%) (Chart 5). Only 25% of women with heart disease worked at least 30 hours a week, compared with 48% of those who were not afflicted.
The main reason that 35- to 64-year-olds with heart disease gave for not working was that they were recovering from an illness or were on disability (30%). By contrast, only 6% of people who did not have heart disease cited illness or disability. Allowing for the age structure of the two groups, the odds that people with heart disease would not be working because of illness or disability were 5.5 times higher than those of people without heart disease.
Economy
Estimates of the cost of cardiovascular disease vary as each takes into account a different inclusions of what are, and are not, costs related to cardiovascular disease in Canada.
A 1996 study on the Economic impact of cardiovascular disease in Canada by Chan B, Coyte P, Heick sought to estimate the total cost of cardiovascular disease in Canada.
In 1994 through a prevalence-based study, from a societal viewpoint, disease-related costs were generated by individuals with cardiovascular disease in 1994, from a societal viewpoint. The human capital approach was used to estimate the value of lost productivity due to illness.
The study initially examined direct costs, in terms of expenditures on hospital care, other institutions, physician services, other health professionals, drugs, research and other items. Secondly the study examined the indirect costs, in terms of lost productivity due to premature mortality or disability.
The study found that the total cost of cardiovascular disease was $18.0 billion in Canada in 1994, with direct and indirect cost components at $10.4 and $7.6 billion, respectively.
This study highlights the scope and magnitude of cardiovascular disease through its economic consequences. The data is now almost 25 years old, however, it remains relevant and applicable today.
According to the Conference Board of Canada, total costs for cardiovascular diseases were estimated to be $12 billion in 2008.10 These costs include both direct costs—that is, drugs, hospitals, physicians—and indirect costs—that is, lost productivity associated with illness, injury, and premature mortality.
According to the Heart and Stroke Foundation of Canada in 2013 / 2014, it is estimated that heart failure results in direct costs of more than $2.8 billion per year in Canada.
Family
Heart failure is a strain on Canadian families.
According to a Heart and Stroke Foundation poll, almost half of Canadians have been touched by heart failure — either diagnosed with it themselves or having a family member or close friend with the condition.
Heart failure patients and their caregivers can feel overwhelmed. “They face a huge psychological and physical burden.
Anxiety and depression are common for people with heart failure,” says Bonnie Catlin. “Around 30 per cent of heart failure patients experience depression with wide ranging symptoms including feeling sad, sleeping too much or not enough, not eating enough and losing interest in activities they used to enjoy.”
Completion of the activities of daily living , attending appointments, managing medications, managing a budget and can be challenging and complex as many heart failure patients are frail and elderly.
The complexity and amount of health information patients receive can be overwhelming. Patients are often physically and emotionally exhausted.
For caregivers, the stress of supporting a loved one with a condition that is complex to manage and whose deterioration is difficult to predict can take its toll.
Patients and caregivers require support and education to manage the condition, slow its progression, and ensure the best quality of life possible.
The heart failure experts surveyed identified a multitude of issues that need to be addressed, including better patient and health professional education, improving continuity of care and providing resources in the community.
My Personal Experience:
I have worked in the field of Social Services for the past 18 years. specifically I work with survivors of Traumatic Brain Injuries. Many of the Patients I work with are survivors of aneurysms and strokes. The complexity of care required and the scarcity of resources to facilitate support cannot be understated. It is an extremely difficult situation for any family member or caregiver to navigate.
For those people of meagre means, a catastrophic event such as a stroke can leave them homeless, or force them to live in care homes which are not regulated and don't provide adequate support in an environment conducive to healing.
Twice as many people with heart disease or living with the effects of a stroke rated their health as being fair or poor compared to people without any chronic condition.
About two thirds of people living with the effects of a stroke and one third of those with heart disease need help with the activities of daily living like personal care, and most report feeling limited in carrying out activities that they previously enjoyed (four in five for stroke and two in three for heart disease).
One in five people with ischemic heart disease or with stroke, up to two in five people with congestive heart failure, and one in three people following a heart attack develop clinical depression. Individuals with both CVD and depression have an impaired quality of life, and increased health problems and risk of death.
In Canada in 2004, CVD was the leading cause of death for Canadians - 72,743 deaths, representing 32% of all deaths.
In 2004, CVD was responsible for an estimated 246,287 potential years of life lost (the number of years not lived, owing to premature death before age 75).
Individuals:
One in five people with ischemic heart disease or with stroke, up to two in five people with congestive heart failure, and one in three people following a heart attack develop clinical depression.
Individuals with both CVD and depression have an impaired quality of life, and increased health problems and risk of death.
In Canada in 2004, CVD was the leading cause of death for Canadians - 72,743 deaths, representing 32% of all deaths.
In 2004, CVD was responsible for an estimated 246,287 potential years of life lost (the number of years not lived, owing to premature death before age 75).
More Canadians are living with damaged hearts. While heart
failure cannot yet be cured, it can be treated and managed.
According to a Heart and Stroke Foundation poll, nine out of 10 know that heart failure can be managed and treated but almost half think it can be cured.
Heart Failure patients have long and frequent hospital stays.
There is currently no cure for heart failure however early detection of risk factors can provide at-risk individuals with knowledge to make lifestyle changes to reduce their risk.
Heart failure patients are often managing co-morbid conditions such as high blood pressure, obesity, and diabetes creating more complex challenges for treatment.
Symptoms can include shortness of breath (dyspnea), exhaustion and swelling.
Patients can expect to encounter some mental health issues such as anxiety and depression. Mindfulness (the practice of being present in the moment) can be an effective tool to counter these issues. Threapy, (group or individual) is also recommended to help patients deal with their feelings. The burden of mental health issues can adversely affect the family unit and relationships between spouses.
Due to the trauma incurred Patients will have to limit or alter future planning such as travel. Patients can also expect significant changes in their lifestyles including loss of employment and employment opportunities which can lead to feelings of anger, frustration and short temperedness. Patients can be resistant to support or can not recognize a need for support.
Media:
The Heart and Stroke Foundation provides Television advertisements, Mail campaigns, Pledge Drives to raise money and awareness about cardiovascular disease and social media campaigns.
https://www.heartandstroke.ca/what-we-do/media-centre
The Government of Canada has information for the public on it's web page.
The Canadian Public Health association and the Public Health Departments in every Municipality provide literature regarding how one can help to prevent cardiovascular disease and sign and symptoms of heart attacks and strokes.
https://www.cpha.ca/preventing-cardiovascular-disease-and-stroke
Most Pharmacies have a section of pamphlets with information on preventing cardiovascular disease and sign and symptoms of heart attacks and strokes
Health Care System
According to CIHI data, hospital visits due to heart failure have increased every year for the past several years with 60,000 reported in 2013–2014.
In fact, the relative increase over the past six years has been 13 per cent.
Currently there are 600, 000 Canadians living with heart failure, and as the population ages these numbers are expected to go up.
Hospitalizations — and associated costs — will grow accordingly, placing increased
burden on our healthcare system.
Heart failure is the third most common reason for hospitalization with the exception of childbirth according to CIHI trailing only respiratory disease and heart attack, both of which are associated with heart failure.
Devices exist that can help failing hearts, and there is room to improve and innovate, as well as broaden access. For example, an implantable cardioverter defibrillator (ICD) is a device implanted to regulate irregular heart rhythms. A left ventricular assist device (LVAD) is a mechanical pump that helps a weakened heart pump blood.
Heart transplant surgery is a risky and complicated procedure. Currently there are not enough donor hearts available to meet the needs of patients. In Canada fewer than 200 heart transplant surgeries are performed each year.
Specialized facilities for heart failure patients are more common in some regions than others; for example Quebec has 47 and in British Columbia there are 22. The specialized clinics support heart failure patients to assess and manage their symptoms, manage medications and support positive behaviour changes such as diet and physical activity.
They also facilitate regular follow-up for patients by cardiologists, internists and GPs, as well as providing access services quickly if they encounter problems.
New and better drugs have recently been approved for use in Canada. However due to the potential for co-morbid conditions, medications need to be closely monitored and adjusted.