According to an article from the National Business Group on Health, the average total (editor's note: lifetime) cost of a severe heart attack–including direct and indirect costs–is about $1 million. Direct (lifetime) costs include charges for hospitals, doctors and prescription drugs, while the indirect costs include lost productivity and time away from work. The average (lifetime) cost of a less severe heart attack is about $760,000. Amortized over 20 years, that’s $50,000 per year for a severe heart attack and $38,000 per year for a less severe heart attack.I'm all for maintaining a healthy lifestyle, but before we get all hot and bothered about performing more testing to "prevent" a heart attack as a means to save health care costs going forward, remember the lessons we learned from the Tim Russert fallout.
Reference: The WISE Study:
Shaw LJ, Merz CNB, Pepine CJ, et al. The Economic Burden of Angina in Women With Suspected Ischemic Heart Disease: Results From the National Institutes of Health-National Heart, Lung, and Blood Institute-Sponsored Women's Ischemia Syndrome Evaluation. Circulation. August 29, 2006 2006;114(9):894-904.
Ok, so all the testing isn't necessarily going to prevent an early death from a heart attack. What is a prudent way to go about getting care if you are at risk of having a heart attack? Should you refuse certain tests at the risk of seeming non-compliant. How would those of us without medical degrees go about deciding which therapies are valuable and which are unnecessary?
Evaluating costs in medicine is important, but I find it even more interesting to look at them in the context of quality improvements. A group of health economists adjusted looked at prices for heart attack treatments from 1983 to 1994 and found that when adjusted for quality (either by gross life years and quality-adjusted life years), the cost of heart attack treatment actually _declined_ over that period. I would love to see whether or not that trend is still there.
(the study in question is here: http://www.nber.org/papers/w7089)
What is a prudent way to go about getting care if you are at risk of having a heart attack? Should you refuse certain tests at the risk of seeming non-compliant. How would those of us without medical degrees go about deciding which therapies are valuable and which are unnecessary?
First, if your are having NO symptoms that might be related to the heart (exertional chest/jaw/back/arm discomfort, shortness of breath at rest or with exertion, palpitations, etc.) and feel fine, I'd be VERY cautious to inquire why your doctor needs the test(s) he or she may be ordering. Remember, if symptoms exist, the doctor is not PREVENTING disease, he is DIAGNOSING disease: a VERY significant difference.
Second, while guidelines have been developed regarding the use of cholesterol screening, hypertension management, nuclear imaging, etc., they are guidelines and most doctors should be able to explain in plain English why they are or are not ordering tests on your behalf. There is no harm in asking your doctor their rationale for ordering a test and what will be done differently depending if the result is "positive" or "negative." If you're not satisfied with your doctor's answer, you should feel free to seek a second opinion regarding your management.
Dr Wes, what are your thoughts on marathon running and incidence of coronary events. Looks like it is risky when people push themselves that extra bit and interval training is better.
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