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Each year cardiovascular disease (CVD) causes over 4.35 million deaths in Europe and over 1.9 million deaths in the European Union (EU).CVD therefore causes nearly half of all deaths in Europe (49%) and in the EU (42%). It is the main cause of death in women in all countries of Europe and is the main cause of death in men in all countries except France and San Marino. Mortality, incidence and case fatality are falling in most Northern, Southern and Western European Countries but either not falling as fast or rising in Central and Eastern European countries. Overall cardiovascular disease is estimated to cost the EU economy €169 billion a year. Of the total cost of CVD in the EU, around 62% is due to healthcare costs, 21% due to productivity losses and 17% due to the informal care of people with CVD.
Source: European cardiovascular disease statistics (2005 edition)
Data from the World Health Organization's Global Burden of Disease Study have shown that in 1990, 6% of years of life lost in disability were due to cardiovascular disease in 'Established Market Economies' (mostly Northern, Southern and Western countries in Europe and all the member states of the EU-15) compared with 4% due to cancer. In 'Formerly Socialist Economies of Europe' (Central and Eastern European countries), 7% of years of life lost in disability were due to CVD compared with 2% due to cancer.
The Global Burden of Disease Study has developed a measure to quantify the burden of disease in different populations which takes into account time lost due to premature mortality and time lived with disability. This measure is called the Disability-Adjusted Life Year (DALY). The 2004 WHO World Health Report described the overall burden of disease in Europe in terms of DALY's lost due to different diseases. It showed that CVD is the major cause of DALY's lost in Europe, responsible in 2002 for 23% overall. CVD is the second main cause of DALY's lost in the EU, responsible in 2002 for 18% overall (exceeded only by neuropsychiatric disorders, responsible for 25% overall).
In the EU alone over 11 million DALY's were lost due to cardiovascular in 2002, of which nearly 5 million were lost due to coronary heart disease (CHD) and over 3 million due to stroke. In Europe as a whole over 150 million DALY's were lost due to CVD in 2002 of which nearly 16 million were lost due to CHD and over 7 million were lost due to stroke (Table 2.2).
Source: World Health Organization's Global Burden of Disease Study
The burden of cardiovascular disease is one of the themes covered by The Silver Book - Chronic Disease and Medical Innovation in an Aging Nation. This recent publication from the Alliance for Aging Research (US-based) provides an overview of the findings of a variety of studies, including some that assess the economic value of investing in innovative treatments and technologies. Similar data for Europe is scarce. However, the main conclusion that can be drawn from the US studies (see below) is valid also for Europe, namely: treating patients with cardiovascular disease is a worthwhile investment, both from the patient's perspective (quality of life, longevity) and from the economic perspective (burden on society).
Some key findings
Source: The Silver Book: Chronic Disease and Medical Innovation in an Aging Nation, Alliance for Aging Research
According to a study by Dr Marc Suhrcke et al. "The contribution of health to the economy in the European Union" (DG SANCO, July 2005), health is to be considered as an investment that brings an economic return and not merely as a cost. This has direct policy implications in that it provides a rationale for policy makers to use health investment within and outside the health sector as one additional means of achieving their economic objectives.
Health thus enters the equation of economic growth since it contributes to:
Dr Suhrcke will provide an overview of this study on the occasion of a Eucomed Forum in Milan on 12 October entitled "Vision 2020 - Apocalyptic or Velvet Revolution in Health Policy Thinking"
Click here to view the study "The contribution of health to the economy in the European Union"
For further analysis of this study, please see our report "Health = Wealth". How much of it has already been achieved?
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The last thirty years have witnessed at least three staggering innovations in the treatment of coronary heart disease. The first occurred in Switzerland in 1977, when Dr Andreas Greuntzig, a German physician, inserted a balloon catheter into a patient's blocked artery and restored blood flow to the heart. A decade later this technique called "percutaneous transluminal coronary angioplasty" (PTCA) rapidly established itself as one of the most common surgical procedures worldwide. However, in as many as 30% of patients who underwent PTCA, restenosis, or re-narrowing of the treated area, occurred.
Stents were introduced to the market during the first half of the 1990s. These small metal scaffolds were developed in order to try and solve the restenosis problem. They are inserted into the artery using PTCA techniques. With the introduction of stents restenosis rates dropped to about 15%. Drug eluting stents (DES) are the latest technology available that help to reduce the rate of restenosis to 7-8%. These second generation devices incorporate a medicinal substance which is progressively released to treat the area of the artery where the stent has been placed and thereby prevent re-narrowing.
The introduction of this drug eluting stents has allowed surgeons to treat patients with more complex conditions, such as diabetics and individuals with smaller vessels and more extensive plaques in the artery. Despite the clinical benefits of DES, concerns about the cost of these devices have been raised. According to the authors of "Medical Devices - Competitiveness and Impact on Public Health Expenditure"(CERM, July 2005), "from the perspective of healthcare providers, the available evidence suggests so far that DES are in fact a cost effective procedure for high risk patients, although unrestricted access to this new technology can generate increases in healthcare costs in the short term".
It is interesting to note that the surgical procedure (balloon angioplasty with a stent) can last as little as 15 minutes. The patient is typically out of hospital in one day and back to work within one week.
Coronary artery bypass grafting is a much more expensive and invasive form of treatment for coronary heart disease. The surgeon reroutes the blood around the blockages in the artery by attaching blood vessels extracted from the patient's leg or chest on either side of the blockage. The operation can last between two and four hours and the patient is hospitalized for at least five or six days. A period of convalescence of six to twelve weeks is required before the patient can go back to work.
Chronic heart failure occurs when the heart is unable to pump enough blood to sustain adequate circulation in the body's tissues. The initial manifestation in heart failure is a decrease in blood output from the left ventricle. In many cases, this decrease in pumping output is accompanied by errant impulses from the heart's electrical system. These can result in accelerated rhythms that adversely affect the heart's ability to pump blood and are potentially lethal.
While heart failure is a serious condition, it is not necessarily the death sentence that its name suggests. Thousands of heart failure patients live well with this condition. Symptoms of heart failure include fatigue, shortness of breath from any type of exertion (Dyspnea), and swelling, usually of the feet and ankles (oedema).
Heart failure is typically a late manifestation of one or more other cardiovascular diseases, including coronary artery disease, hypertension and valvular disease. Restricted blood flow to the heart muscle (coronary artery disease or ischemic heart disease) is thoughtto account for approximately 70 percent of heart failure cases. Numerous other disorders and factors may also contribute to the development of heart failure, including metabolic disturbances, toxins or infections, hypersensitivity reactions, and genetic diseases. Up to 50 percent of patients with advanced heart failure have electrical conduction problems within the heart, such as rapid heartbeats, which may contribute to a worsening of symptoms. As treatment has improved for other heart conditions, particularly myocardial infarctions (heart attacks), more patients survive the short-term event only to develop heart failure later.
Cardiac resynchronization therapy (CRT) is a treatment for heart failure that uses an implantable device to improve the pumping efficiency of the heart and increase blood flow to the body. By improving blood flow, CRT may help to reduce heart failure symptoms and improve quality of life. Cardiac resynchronization therapy, also known as biventricular pacing is intended to complement standard drug therapy, and dietary and lifestyle modifications. A major clinical study involving over 1.500 patients, the COMPANION trial, has demonstrated that CRT considerably reduces mortality and hospitalisation in advanced heart failure patients. The results of the CARE-HF study go in the same direction.
Some heart failure patients may also be at risk for sudden cardiac death and are eligible to receive an implantable-cardioverter defibrillator (ICD), a device that uses electrical impulses to stop fatal heart rhythms, or a combination CRT/defibrillator. Recent studies have shown that ICD therapy significantly reduces death from sudden cardiac arrest in patients with heart failure and poor heart pumping function.
The ICD is used in primary prevention, for patients who have had a myocardial infarction or a familial cardiac condition with a high risk of sudden death. Major primary prevention trials have shown that patients implanted with defibrillators had over 50% improvement in survival compared with control patients. ICDs are also used in secondary prevention, for patients who have survived a cardiac arrest for example. A meta-analysis of studies of implanted defibrillators for secondary prevention showed that they reduced the relative risk of death by 28%, almost entirely due to a 50% reduction in risk of sudden death. (source: BMJ, Volume 327, August 2003: click here to view report).
A left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that is surgically implanted. This device is sometimes called a "bridge to transplant". It helps maintain the pumping ability of a heart that can't effectively work on its own (the left ventricle is the large, muscular chamber of the heart that pumps blood out to the body).
Tissue engineering is an emerging medical technology sector, which promises to change medical practice profoundly, regenerating diseased tissues and organs instead of just repairing them. The development of tissue engineering-based treatments for cardiovascular disease is well underway for heart valves, vessel grafts and heart muscle tissue.
Current heart valves (donor, xenogeneic and mechanical) encounter several problems, including limited durability, shortage of supply, and the inability to grow (posing a problem for childhood patients). Tissue-engineered valves would avoid these problems as they are living replacements, capable of growing with the patient.
Current vessel replacements include autologous grafted vessels (which are not always available), and stents made of Dacron (which have a tendency to clog quite quickly when diameters of less than 4mm are used). Current research activities aim to develop blood vessels capable of replacing natural vessels with regards to vasoactivity (which controls the flow of blood through individual organs), appropriate mechanical properties, and which do not cause/result in thrombosis or coagulation of the blood.
Heart muscle tissue, damaged by a heart attacked which in turn impairs the functioning of the heart, is a further research area. Normally it is impossible to reverse damage to heart muscle tissue. Current tissue-engineering research focuses on growing patches of heart muscle tissue or, for the time being, on cell therapy-like approaches (such as the transplantation of healthy cells into the damaged area).
Source: Human tissue-engineered products - Today's markets and future prospects
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There are many more exciting new developments in the field of medical technology. If you would like more information, please contact Mark Grossien, Director Communication & External Affairs, Eucomed - E-mail: mark.grossien@eucomed.be or consult previous editions of Medical Technology Focus
Join us in Milan on 12 October for a stimulating Forum entitled "Vision 2020 - Apocalyptic or Velvet Revolution in Health Policy Thinking?" Guest speakers include Dr Marc Suhrcke, World Health Organization, co-author of "The Contribution of Health to the Economy in the European Union" (European Commission, 2005) and Wim Oostrom, PricewaterhouseCoopers, authors of "HealthCast 2020: Creating a Sustainable Future" (2005). A panel of distinguished experts will discuss the economic challenges of rapid technological change, growing patient expectations and ageing populations; and explore new avenues beyond the traditional cost containment reflex. The audience will essentially comprise medical technology industry business leaders and opinion formers from Europe, the United States, Australia, Canada and Japan.
"Vision 2020: Apocalyptic or Velvet Revolution in Health Policy Thinking?" is one of the events taking place in the margins of the Eucomed Annual General Meeting. Registration is indispensable. Participants are also invited to attend a reception and typical Italian dinner on the evening of 12 October (limited number of seats available), as well as a presentation by Italian Senator and former Minister for Innovation and Technology, Lucio Stanca, on the morning of 13 October.
The Forum "Vision 2020 - Apocalyptic or Velvet Revolution in Health Policy Thinking?" will take place at the Westin Palace Hotel, Milan, Italy, on 12 October 2006, in the margins of the Eucomed Annual General Meeting.
