Introduction on The Bi-directional Impact of Two Chronic Illnesses: Heart Failure and Diabetes – A review of the Epidemiology and Outcomes
Heart failure remains a significant burden to the US healthcare system and contributes greatly to the morbidity and mortality of the population. The impact of an ageing population, improved survival in coronary artery disease (CAD) and adverse life-style choices will ultimately result in an increased burden on an already taxed health care system.
Heart failure affects over 5 million people with approximately 550,000 new cases every year.1 While the prevalence of heart failure is significantly higher in the older population (>65 years), 1.4 million patients <60 years of age carry the diagnosis of heart failure. The estimated $32 billion cost of heart failure is due in large part to the more than 1 million hospital admissions for acute care. Following the first admission for acute decompensated heart failure (ADHF) the readmission rates are nearly 50 % at six months and mortality reaches 30 % at 1 year.2,3 The short-term risk of readmission remains unacceptably high, 15 % at 60 days and 30 % at 90 days. Unfortunately even with all of the advances in medical therapy the post-admission morbidity and mortality has not been significantly reduced. As with most chronic illness, the impact of co-morbidities adversely affects the outcomes in heart failure.
Diabetes mellitus (DM) has been shown to be a significant risk factor for the development of heart failure and negatively impacts the prognosis. Over the past two decades the prevalence of diabetes has sharply increased from 3.5 % in the 1990s to greater than 9 % in 2012.4 Diabetes impacts the lives of nearly 30 million Americans and by the age of 65 nearly one quarter of the population carries the diagnosis. The cost of DM to the health care system is nearly $250 billion, with close to $175 billion in direct costs.5
Traditionally the two illnesses have been managed in relative isolation. However with the high incidence of the co-existence of these two chronic diseases, especially as the prevalence of both continue to grow, clinicians should be more cognisant of the impact each has on the other.