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BACKGROUND: Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial. METHODS: Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics. RESULTS: We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic. CONCLUSIONS: The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends. [ABSTRACT FROM AUTHOR]

The article discusses the health economics of cardiovascular disease (CVD) in the United States. CVD is the leading cause of morbidity and mortality in the country, resulting in significant direct medical spending and indirect costs. The economic burden of CVD is felt at various levels, including society, clinicians, and individual patients or families. Factors such as obesity, hypertension, and the increasing cost of cardiovascular medications and procedures contribute to the rising medical spending and indirect costs associated with CVD. Demographic shifts, including the aging and diversification of the population, are projected to drive cost growth and the need for cardiovascular services. Structural and systemic racism and other inequities contribute to the disproportionate burden of CVD borne by Black, Hispanic, and Native American individuals. The tension between the price and speed of innovation and health economics is also discussed, with high-priced but highly effective drugs facing challenges in uptake due to their unaffordability. The article emphasizes the need for policy interventions to address these issues, including reducing the unit costs of high-priced treatments, increasing access to innovative care, and reducing health care spending through prevention and addressing high prices. The economic trends facing clinicians, such as consolidation, corporatization, and private equity ownership, are also highlighted, along with the financial burdens faced by individuals and families affected by CVD. The article concludes by emphasizing the importance of prioritizing access, quality, and prevention to maximize cardiovascular health for all individuals in the United States. [Extracted from the article]

Despite higher per-capita health care spending than any other country, the United States lags far behind in health outcomes. Additionally, there are significant health inequities by race, ethnicity, socioeconomic position, and rurality. One set of potential solutions to improve these outcomes and reduce inequities is through health policy. Policy focused on improving access to care through insurance coverage, such as the Affordable Care Act's Medicaid expansion, has led to better health and reduced mortality. Policy aimed at improving health care delivery, including value-based payment and alternative payment models, has improved quality of care but has had little impact on population health outcomes. Policies that influence broader issues of economic opportunity likely have a strong influence on health, but lack the evidence base of more targeted interventions. To advance health outcomes and equity, further policy change is crucial. [ABSTRACT FROM AUTHOR]

A study published in the European Heart Journal analyzed trends in cardiovascular hospitalizations and in-hospital mortality among young and middle-aged adults in the USA between 2008 and 2019. The study found that hospitalizations for acute myocardial infarction, heart failure, and ischemic stroke increased during this period, while in-hospital mortality rates for these conditions slightly declined. The burden of comorbidities, particularly diabetes, kidney disease, and obesity, also increased among hospitalized patients. The study highlighted disparities in hospitalization rates and mortality based on income and insurance status, with low-income individuals and people identifying as Black or Hispanic being disproportionately affected. The authors suggested that a multifaceted approach is needed to address the increasing rates of hospitalizations and disparities in cardiovascular health, including raising awareness of disparities, improving access to care, and implementing interventions that address social determinants of health. [Extracted from the article]

OBJECTIVES: In 2018, CMS established reimbursement for the first Medicare-covered artificial intelligence (AI)--enabled clinical software: CT fractional flow reserve (FFRCT) to assist in the diagnosis of coronary artery disease. This study quantified Medicare utilization of and spending on FFRCT from 2018 through 2022 and characterized adopting hospitals, clinicians, and patients. STUDY DESIGN: Analysis, using 100% Medicare fee-for-service claims data, of the hospitals, clinicians, and patients who performed or received coronary CT angiography with or without FFRCT. METHODS: We measured annual trends in utilization of and spending on FFRCT among hospitals and clinicians from 2018 through 2022. Characteristics of FFRCT-adopting and nonadopting hospitals and clinicians were compared, as well as the characteristics of patients who received FFRCT vs those who did not. RESULTS: From 2018 to 2022, FFRCT billing volume in Medicare increased more than 11-fold (from 1083 to 12,363 claims). Compared with nonbilling hospitals, FFRCT-billing hospitals were more likely to be larger, part of a health system, nonprofit, and financially profitable. FFRCT-billing clinicians worked in larger group practices and were more likely to be cardiac specialists. FFRCT-receiving patients were more likely to be male and White and less likely to be dually enrolled in Medicaid or receiving disability benefits. CONCLUSIONS: In the initial 5 years of Medicare reimbursement for FFRCT, growth was concentrated among well-resourced hospitals and clinicians. As Medicare begins to reimburse clinicians for the use of AI-enabled clinical software such as FFRCT, it is crucial to monitor the diffusion of these services to ensure equal access. [ABSTRACT FROM AUTHOR]