Experts fear that heart failure will be the next pandemic
EVEN before Covid-19 brought the world to its knees last year, heart failure, which continues to dominate the cardiovascular disease landscape, has already been pervasive globally, affecting at least 26 million people worldwide, according to a medical expert.
“Heart failure is a pandemic that has been with us since the time of ancient Egypt and old civilizations in Greece, India, and the Romans, you name it,” Dr. Erlyn P. Demerre, chair of the heart failure program at St. Luke’s Medical Center, told reporters in a recent webinar hosted by Astrazeneca Philippines. “The word ‘pandemic’ is now a household word because of the coronavirus, and governments are united in working hard, spending man hours just to flatten the curve.”
Patients with heart failure commonly experience physical and emotional symptoms. Such a condition restricts their activities resulting in poor quality of life. Even when resting, some of them start experiencing shortness of breath. Their feelings get heavier each day, thus making them very vulnerable. For many patients living with this condition is like waiting for death. More so, they feel guilty that they cause a huge economic and emotional burden on their families.
“Much work has been put into the study of heart failure and we are definitely in a better position in the diagnosis and management of heart failure now. But, ironically, despite optimal medical management and significant advancements in therapy and prevention, heart failure is a major and increasing burden all over the world with high mortality and morbidity, and poor quality of life,” she noted, adding that it is also an important contributor to the problems of “[high treatment] cost and loss of productivity in our society.”
Global picture
EVERYWHERE in the world, heart failure constantly poses a threat to the lives of millions of people and substantial challenges to the health-care industry.
Citing global statistics, Dr. Demerre revealed that the overall known prevalence rate of heart failure is between three and 20 patients per 1,000 population, and this rises to a hundred in those aged 65 years and above.
She bared that the annual incidence of heart failure is one to five per 1,000 people annually, the relative incidence doubles for each decade of life after the age of 45, and one in three patients dies within a year. One out of four is readmitted in the hospital for 30 days with increased morbidity and poor quality of life.
“The high readmission rate of heart failure accounts for approximately two-thirds of all costs related to its management, and the global cost of the burden of disease is estimated at $108 billion,” added Demerre who is also the director of the National Heart Failure Network Task Force and the senior adviser of the Advocacy Committee of the Philippine Heart Association.
Based on the Health Analysis Asia’s report in 2019, cardiovascular disease (CVD) deaths and economic prosperity are found to be inversely proportional in Asia, particularly in Pakistan, Indonesia, Lao PDR and the Philippines with the highest registered numbers of fatality.
“The World Health Organization reiterates the fact that the poorest people in the low- and middle-income countries are affected the most by CVDS. So the condition places a heavy economic burden on low- and middle-income countries. And we know the Philippines is not really a rich country,” she pointed out.
Regional, local scenarios
BY the numbers, the Philippines and its fellow member-states of the Association of Southeast Asian Nations (Asean) are still in the midst of the fight against heart failure.
Discussing the latest developments on heart failure in the region with a growing population of more than 600 million people, Professor David Sim, president of the Heart Failure Society in Singapore, divulged that researchers have found that 9 million people in Southeast Asia have this cardiovascular condition with an overall 15 percent mortality rate.
Referring to the publication by Dr. Caroline Lam of Singapore in 2015, Dr. Demerre disclosed that the prevalence of symptomatic heart failure is higher among Asean members compared to the rest of the world.
She added that the majority of the population in Southeast Asia is younger than 65 years, but the rapid epidemiological transition in this age group has led to high rates of premature death from noncommunicable diseases, chiefly cardiovascular disease.
“And that’s up to 28 percent in the Philippines compared to 12 percent in the UK [United Kingdom],” she said of its pervasiveness among the Filipino youth.
The figures in Southeast Asia, for her, clearly manifest that hospitalizations due to this health condition are on the rise, and compared with western counterparts, its decompensation occurs at a younger age and is characterized by more severe with worse outcomes.
“Heart failure has many phases and stages and can be referred to by different names and shades. But it is the same final common pathway of heart disease in the cardiovascular continuum that starts with the development of risk factors,” Dr. Demerre explained.
Mirrored situation
While data in heart failure cases in the country are limited, foreign and local studies suggest that regional findings mirror the situation here.
In the same report by Dr. Lam, for instance, she underscored that even with known and proven effective treatments available, “there is under usage of disease modifying heart failure therapies among Southeast Asian patients, and I’m sure this is the case in the Philippines.”
Another study that was published in 2017 by Dr. Bernadette A. Tumanan-mendoza et al. in Heart Asia determined the prevalence of hospitalization due to congestive heart failure among adult Filipino patients aged 19 years old and above.
“They concluded that for every 1,000 Filipino patients admitted due to a medical condition, 16 cases were because of heart failure. This was in 2014. There was no gender predilection and hypertension was possibly the most common cause of heart failure,” she said.
Dr. Demerre associated the lower socioeconomic status with increased incidence of heart failure as resonated in 28 studies reviewed and published in the European Journal of Heart Failure.
Collectively, their results indicated that the adjusted risk for developing heart failure was increased by about 30 to 50 percent in low- to middle-income countries and, likewise, readmission rates following hospitalization were greater in more economically-deprived patients.
“Although fewer studies examined mortality, lower socioeconomic status was associated with poorer survival. Although [the] evidence they find in the equity of medical treatment of patients with heart failure was scarce and conflicting, we know that socioeconomic deprivation is a powerful independent predictor of heart failure development and adverse outcomes,” she reiterated.
The collated studies confirmed that the proportion of poor Filipinos, whose per capita income is not enough to meet their basic needs, was high. It started to decline though to 16.6 percent in 2018, translating to 17.6 million Filipinos who live below the poverty threshold estimated at P10,727 for a family of five per month.
Given their economic status, she asserted that it could still not save them considering that the total economic burden for heart failure hospitalization was close to P1 million per patient, as shown in another study of Dr. Mendoza and her colleagues three years ago.
“We are not so rich [as a] country. We are struggling with heart failure. So looking at the history from the ancient world to what we have seen now over the last two or three decades, there has been considerable progress in the treatment of heart failure that are now considered major pillars in the ideal management of a heart failure,” said Dr. Demerre.
“But despite all these advances, heart failure is still on the rise and is associated with a poor prognosis. We haven’t really flattened the curve. With the many compounding factors in heart failure care, the Philippines has a long way to go. The important thing is we have set our goals, united in the fight against heart failure,” she stressed.