Epidemiology

Ischaemic heart disease is the single largest cause of death worldwide and is commonly associated with myocardial infarction.1

According to the WHO, 17.5 million deaths in 2012 were attributable to cardiovascular disease, with 7.6 million (42.5% of all cardiovascular deaths) being due to the result of ischaemic heart disease.2

Cardiovascular disease is a major cause of death worldwide1

Major causes of death Worldwide

Mortality rate: difference between countries

Heart disease mortality rates are affected by differences in geographical location. The highest numbers of death from cardiovascular disease are reported from China, India, Russia, Ukraine, and the USA.3

Geographical differences in mortality from ischaemic heart disease (IHD), estimates 2012

Deaths (x 1000) from IHD in WHO regions

Geographical differences in mortality from ischaemic heart disease (IHD), estimates 2012

Coronary heart disease and resulting death rates are decreasing in many developed countries, especially North America and western European countries. This decrease is the result of improved prevention, diagnosis and treatment, particularly reductions in cigarette smoking, blood cholesterol and blood pressures.4,5

Trends in mortality rates from cardiovascular disease in developed countries4

Trends  in  mortality  rates  from  cardiovascular  disease  in  developed  countries Line diagram showing decrease in coronary heart disease and resulting death rates in developed countries

In particular, a large, population-based study in the US showed a significant decrease in the incidence of myocardial infarction and especially in ST-segment elevation myocardial infarction (STEMI) from 1999 to 2008.6

In developing and transitional countries, coronary heart disease is increasing, partly as a result of increasing longevity, urbanisation, and lifestyle changes. More than 60% of the global burden of coronary heart disease occurs in developing countries.4

A 30-year registry in Japan has also shown an increase in the incidence of myocardial infarction, probably as a result of increasing longevity of the population, a high rate of smoking and an increasingly more westernised lifestyle.7

Worldwide, data show that men are more likely than women to have an acute myocardial infarction (AMI) and that the risk of having an AMI increases with age.4

Deaths due to cardiovascular disease, according to gender8

Deaths  due  to  cardiovascular  disease  according  to  gender

For people aged over 60 years, coronary heart disease is the most likely cause of death worldwide and the incidence of acute myocardial infarction increases in both sexes with age, although this is more marked in men than in women.4,9

Prevalence of acute myocardial infarction, according to age and sex (US data 1999-2008)9

Prevalence  of  acute  myocardial  infarction  according  to  age  and  sex   Data analysis for years 1999-2008 in US

Cardiovascular disease is responsible for 10% of the disability-adjusted life years (DALYs) lost in low- and middle-income countries and 18% of DALYs lost in high-income countries (DALYs combine years of potential life lost due to premature death with years of productive life lost due to disability, thus indicating the total burden of the disease).4

Distribution of global CVD burden (DALYs) due to cardiovascular diseases in men and women

Distribution  of  global  CVD  burden  due  to  cardiovascular  diseases  in  men  and  women          WHO report on global prevention and control of cardiovascular diseases, 2011

Over the next decades, the worldwide burden of disease is predicted to increase for cardiovascular disease, whilst infective diseases are likely to present a decreased burden.4

Changing worldwide burden of disease*, as % of total DALYs, in 2004 and predicted for 2030

Changing  worldwide  burden  of  disease  as  percent  of  total  DALYs  in  2004  and  predicted  for 2030 WHO prediction on global burden of prevalent diseases in 2030 in comparison to 2004

The healthcare costs of cardiovascular diseases (CVD) are set to rise to an estimated 98.7 billion Euros according to the EU forecast for the year 2020. The CEBR analysis on the economic cost of cardiovascular diseases 2014-2020 in six European economies was evaluated with Sweden having the lowest costs and Germany the highest.10

Forecast EU 2020:
Healthcare costs of CVD to rise to 98.7€ billion

Healthcare costs of CVD

The total direct and indirect costs of CVD and stroke in the United States for 2011 were estimated at $320.1 billion. This includes heart disease, stroke, hypertensive disease and other circulatory conditions.11

Heart disease alone in the US in 2011 cost a total of $215.6 billion:11

  • $116.3 billion in direct costs (emergency room, inpatient care, home healthcare, and prescriptions).11
  • $99.3 billion in indirect costs (loss of productivity, resulting from morbidity and mortality).11
  • By comparison, in 2010 the estimated cost of all cancers in the United States was $124.57 billion.12

 

Direct and indirect costs of cardiovascular disease and stroke, USA, 2011.11

Direct and indirect costs of cardiovascular disease and stroke, USA 2011

Costs of acute myocardial infarction (AMI)

  • Based on 18 studies from the US, EU and Australasia, the mean (median) cost of AMI is $11,664 ($7,342), although the average costs are higher for diabetics13
  • Based on 3 US studies and 1 Swiss registry, the mean (median) cost for follow-up through 1 year is $32,279 ($27,430)13
  • In China, the cost of AMI is increasing, with data from Beijing showing a 56.8% increase from 2007 to 2012 (even after adjusting for inflation)14

Costs associated with AMI13

Costs associated with AMI

References: 
  1. Ibanez B, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2018;39:119-177.  
  2. World Health Organization 2014. Global health estimates 2014 summary tables: deaths by cause, age and sex, by WHO region, 2000-2012.
  3. Nowbar A, et al. 2014 Global geographic analysis of mortality from ischaemic heart disease by country, age and income; Statistics from World Health Organisation and united Nations. Int J Cardiol 2014;174(2):293-298.
  4. Mendis S, Puska P, Norrving B, editors. Global Atlas on Cardiovascular Disease Prevention and Control. World Health Organization, Geneva 2011.
  5. Go AS, et al, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2013 update: A report from the American Heart Association. Circulation 2013;127:e6-e245.
  6. Yeh RW, et al. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362:2155-2165.
  7. Takii T, et al. Trends in acute myocardial infarction incidence and mortality over 30 years in Japan: Report from the MIYAGI-AMI registry study. Circ J 2010;74:93-100.
  8. WHO. Cardiovascular diseases (CVDs) Fact sheet No. 317. September 2012. Accessed 14.2.2013 at: http://www.who.int/mediacentre/factsheets/fs317/en/index.html
  9. National Institutes of Health, National Heart, Lung and Blood Institute, 2012. Morbidity and mortality: 2012 chart book on cardiovascular, lung, and blood diseases.
  10. CEBR. The economic cost of cardiovascular disease form 2014-2020 in six European economies. August 2014. Accessed 30.04.18 from: https://www.cebr.com/wp-content/uploads/2015/08/Short-Report-18.08.14.pdf
  11. Mozaffarian D, et al. Heart disease and stroke statistics – 2015 update: A report from the American Heart Association. Circulation 2015;131:e29-e322.
  12. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, and Brown ML. Projections of the Cost of Cancer Care in the United States: 2010-2020. J Natl Cancer Inst 2011;103:117-128.
  13. Nicholson G, et al. Patient-level costs of major cardiovascular conditions: a review of the international literature. Clinical Economic Outcomes Res 2016;8:495-506.
  14. Zhang Q, et al. Recent trends in hospitalization for acute myocardial infarction in Beijing: increasing overall burden and a transition from ST-segment elevation to non-ST-segment elevation myocardial infarction in a population-based study. Medicine 2016;95(5):e2677.
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