The Problem of Heart Disease

Paper Summary:

This research explores those methods which have been developed, and found effective in treating heart disease. The paper starts with an analysis of the types of heart disease, their increase in incidents and some of the proximate causes. It then discusses technologies that have been developed or perfected to deal with heart disease in two areas: revascularization using PCI, or percutaneous coronary intervention, and CABG, or coronary artery bypass graft surgery. Next, the paper analyzes development in aortic valve treatment, including aortic valvuloplasty, aortic valve replacement surgery, and the newly-emerging minimally-invasive approaches to aortic valve replacement, both surgical and percutaneous. The writer posits that, despite fairly dramatic reductions in heart attack systems and a slight decrease in heart-related deaths in the United States and other first-world countries, the application of technology has had mixed results. Several photos and an annotated bibliography are included with the paper.

Outline:
Introduction
Scope of the Problem of Heart Disease
Ethnic Group
Sex
Region
Age
Socioeconomic Factors
Biochemical Factors
Escalating Costs Associated with New Technology for Coronary Artery Disease
Pharmaceutical Treatment of Patients with Heart Disease
Emergency Room Treatment
CABG Cost Discussion
Primary Coronary Intervention
Post-AMI Angioplasty
Reservations on Cost Comparisons
Direct Costs for New Devices
Who Controls the Patient?
Rising Costs to Patients
Quality of Life
Conclusions for CABG and PCI
Aortic Valve Replacement
Current Method of Treatment: Surgery or Valvuloplasty
Percutaneous Aortic Valve Replacement
Rivalry between Physician Groups and Impact on Practice Volumes
Subapical Valve Replacement
Patient Benefit
Costs and Benefits for Aortic Valve Replacement
Conclusion

From the Paper:

"The highest incidence of heart and circulatory disease is amongst the Pima Indians of the deserts of Arizona. Their rates of obesity, diabetes and heart disease are four times higher than the average American. When all other factors are taken into account, the genetic component is a major causative factor for heart disease.
Blacks and Hispanics have a significantly higher rate of heart disease as well. As with all analyses of causative factors, there is a close correlation between obesity, lack of exercise and Type-2 diabetes in these ethnic groups as well. This could indicate that, because these ethnic groups are more susceptible to these confounding factors, they are therefore more prone to heart and circulatory disease. There is also a concern that, in addition to having a higher incidence of obesity and heart disease, that blacks are less likely to receive echocardiograms, stress EKG's, angiograms and angioplasty. Blacks tend to have a higher incidence of high blood pressure, high cholesterol and obesity than whites. This is particularly true for black women, 55% of whom are classified as 'obese' (i.e. a BMI of greater than 30 percent) (AORN, 2002). Black men also have a higher obesity rate than white men, and on a par with white women.
Those of South Asian (Indian, Pakistani) and Middle Eastern ethnicity tend to have higher rates of heart disease."

Sample of Sources Used:

• AACAP. (2001, January). Obesity in Children and Teens. Retrieved February 19, 2008, from Am Acad Child & Adolescent Psychiatry: http://www.aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens
• AHA. (2007). Heart Disease and Stroke Statistics. Chicago: AHA.
• AORN. (2002). Incidence of heart disease death high for African Americans . AORN Journal , n.p.
• Boden, W. (2004). Surgery, angioplasty or medical therapy for symptomatic multivessel coronary artery disease, is there an indisputable winning strategy from evidence-based clinical trials? JACC , 1752-1754.
• Briguori, C. S. (2002). In-stent restenosis in small coronary arteris: Impact of strut thickness. JACC , 403-409.

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