Lifetime Cost of Women's Angina Tops $1 Million

Even mild artery blockages can trigger serious expense, study finds

MONDAY, Aug. 21, 2006 (HealthDay News) -- Chest pain isn't cheap.

A new U.S study finds that the lifetime bill for treating a woman's heart disease-linked angina could total $1 million.

Even chest pain associated with "mild" artery blockages -- called nonobstructive coronary artery disease -- could top $750,000 or more per woman over her lifetime, the researchers found.

"I was really astounded," said Leslee J. Shaw, professor of medicine at Emory University, Atlanta, the lead author of the study. "We went into this thinking it was $300,000 over a lifetime, that was the figure that was previously guess-timated."

Her team published its findings in the Aug. 22 issue of Circulation.

According to Shaw, the study's aim was to provide health care administrators with data that would help them better allocate scarce health care resources -- especially for female patients who might need more interventions.

The figures include medical care, plus an estimate of indirect costs to society linked to heart disease: lost work hours, transportation costs and out-of-pocket costs for drugs and alternative therapies.

The findings shouldn't dissuade women from seeking out care when chest pain strikes, however.

"Women should not take this as something to scare them off from getting evaluated [due to the cost]," said Dr. Nieca Goldberg, chief of women's cardiac care at Lenox Hill Hospital in New York.

Shaw and her colleagues evaluated 883 women referred for coronary angiography (a specialized X-ray exam of the coronary arteries). All were part of the Women's Ischemia Syndrome Evaluation (WISE) study.

That study -- begun in 1996 and sponsored by the U.S. National Institutes of Health -- has produced numerous reports focused on women and heart disease.

Shaw's team compared data on the women's health, their personal finances and their quality of life over a period of at least five years.

Of the total, 62 percent had non-obstructive coronary artery disease, defined as blockage of less than 50 percent of the vessel. Seventeen percent had one vessel either blocked or narrowed, and 11 percent had two vessels narrowed. Ten percent had three affected vessels.

Shaw's group found that nearly two-thirds of the women had heart disease, but that they had no significant vessel narrowing and so weren't considered "high-risk." But her group assumed that these women wouldn't have as many medical needs as women with blockages of one or multiple vessels. They were incorrect, however, and found that medical bills steadily mounted for this group, as well.

The reason, they concluded, was ongoing angina, which can occur when the heart does not get enough blood and oxygen. This drove these otherwise "low-risk" women back to the doctor for help.

At the one-year mark, Shaw's team found, the number of repeat angiograms or hospitalizations for chest pain was 1.8 times higher in those with nonobstructive heart disease as in those with one vessel obstructed.

At the five-year mark, 20 percent of women with nonobstructive heart disease had been hospitalized for chest pain, while 55 percent of those with three-vessel disease had been hospitalized.

Women with either nonobstructive or one-vessel heart disease also had the highest drug treatment costs. Drugs to improve blood flow to the heart made up nearly 15 percent of total costs in those with nonobstructive disease and about 12 percent to 14 percent of total health care costs for women with obstructive disease.

Out-of-pocket costs for health care over the five years of the study totaled more than $32,000 for female patients with nonobstructive disease and more than $53,000 for those with three affected vessels.

Lifetime costs for women with obstructive disease were estimated at $1 million, while women with nonobstructive disease racked up bills of over $750,000, the study concluded.

"Many of these women didn't have prescription drug coverage, so they were paying for these very expensive drugs out-of-pocket," Shaw said.

Overall, Shaw noted in the study report, health care costs for coronary heart disease in the United States now total $368.4 billion.

The message to women is clear, said Goldberg. "The time to get symptoms evaluated is when you first start to feel them." Early intervention can help improve prognosis while holding down costs, she said.

"We need to put more value on prevention," she added. "Right now, we [doctors] are focusing on high-technology tests." Doctors should focus more on the patients as people, she said, and listen closely to their symptoms to better decide which tests are needed.

"Patients need to be proactive," Shaw added. A woman who can't afford the out-of-pocket costs of prescribed drugs, she said, should consider asking her doctor to help her find out about subsidized drug programs that might be available.

More information

To learn more about women and cardiac health, visit the U.S. National Heart, Lung, and Blood Institute.

SOURCES: Leslee J. Shaw, Ph.D., professor, medicine, Emory University, Atlanta; Nieca Goldberg, M.D., chief, women's cardiac care, Lenox Hill Hospital, New York City; Aug. 22, 2006, Circulation

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