The Role of Prevention in Reducing Cardiovascular Health Care Costs

Healthcare costs related to cardiovascular disease alone have a tremendous impact on the economy in the United States, totaling more than 400 billion dollars – and they are expected to rise to a staggering one trillion dollars by the year 2035.¹ Currently, there is no evidence to support universal screening for cardiovascular disease (CVD), similar to that for various types of cancer. However, as Shaw and colleagues recently reported from their analysis estimating 10-year cardiovascular disease costs of the Multi-Ethnic Study of Atherosclerosis (MESA) study, improved detection and prevention of advanced subclinical CVD could significantly influence long-term health and reduce future health care costs.¹

MESA was a registry of over 6,000 healthy individuals.² The socioeconomic features of the study participants included a diverse population with about 40% reporting a history of a risk factor diagnosis such as dyslipidemia or hypertension. In addition, there was a strong correlation between an individual’s risk factors and comorbidities and an increase in CVD events.² A key finding of the MESA study was that a person’s socioeconomic status directly affected resource consumption and further increase costs related to CVD.

In the MESA study, participants were scored with a risk stratification tool called the Framingham risk score (FRS), and a 10-year predicted risk was tallied.² Data included cardiac risk factor history-taking, including family history of CVD and any history of tobacco use. The study participants were asked to report any personal diagnosis of diabetes, hyperlipidemia, and hypertension.² Their lipids, glucose, and blood pressure were also measured. The study showed that overall health care costs increased as the individual’s risk increased from low to high but also as age increased. Additionally, health care cost increases also correlated with higher coronary artery calcium scores.¹ 

The cost of CVD medications exhibited the most substantial portion of the 10-year costs. Low-risk participants resulted in a total 10-year mean expense of about 8 million dollars, while the high-risk participants totaled approximately 74 million dollars in CVD health care costs.¹

Prevention is the best weapon that healthcare can employ to help reduce CVD health care costs.¹ Finding ways to maintain a population for several years that is at low risk for CVD will benefit the individual but also public health as a whole. It will also drive down health care costs. Thus, investing in successful prevention programs should be the new initiative of cardiovascular health care. Community programs that raise awareness of cardiovascular disease, educate about CVD risk factors, and demonstrate how to make favorable lifestyle changes would reduce the need for costly medications and long-term clinical care.¹ Additionally, reaching vulnerable populations may require health policy initiation through local and state government that focuses on improving health behaviors, such as access to healthier food options, the importance of physical activity, and tobacco control.

Community programs play a pivotal role in improving the overall quality of life, prevention of disease, and improving the health of its population. Therefore, if more programs were directed toward CVD prevention, it would substantially benefit the people in a given community.¹ Some of the most common arenas to provide community outreach include schools, workplaces, healthcare facilities, and community activities.  For example, employers providing a farmer’s market at work offers employees access to fresh produce in a cost-effective manner that is also easily accessible.

Nurses are vital stakeholders for providing awareness and education within clinical settings and communities for CVD prevention. We can influence change by educating people regarding the importance of lifestyle changes. Lifestyle modifications will empower the population, thus having an impact on reducing health care costs associated with CVD and improve overall public health.¹ Nurses could collaborate with community leaders to raise awareness of the importance of prevention, since leading risk factors (obesity, tobacco use, physical inactivity, high cholesterol, and high blood pressure) are those that are most effective in prevention, when modified. Prevention is the most critical tool we can use to fight cardiovascular disease and alleviate the economic burden as a result.

1. Shaw, L. J., Goyal, A., Mehta, C., Xie, J., Phillips, L., Kelkar, A., … & Blaha, M. J.. 10-Year Resource Utilization and Costs for Cardiovascular Care. Journal of the American College of Cardiology, 2018;71(10), 1078-1089. 
2.  Bild, D. E., Detrano, R., Peterson, D. O., Guerci, A., Liu, K., Shahar, E., … & Saad, M. F. Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation, 2005;111(10), 1313-1320.