There’s a heavy burden on my heart

Experts from the Higher School of Economics have for the first time assessed how the macroeconomics of Russia is affected by atrial fibrillation, a disease in which the rhythm of the heart is disturbed. According to their calculations, by 2036 the number of patients with such arrhythmia could exceed 3 million. The damage to the economy from it will amount to 962.1 billion rubles. up to 1566.6 billion rubles. The study authors note that the development of atrial fibrillation especially affects the loss of working years among Russian men: this disease accounts for more than 35% of all deaths among them. Cardiologists confirm that the problem of arrhythmia is underestimated. In their opinion, it is necessary to educate the population about the importance of monitoring the state of the cardiovascular system and at the same time produce more specialized medical equipment.

Atrial fibrillation, also known as atrial fibrillation, is a disease associated with irregular heart rhythm. Normally, the heart contracts at a frequency of 60 to 80 beats per minute, and contractions are performed alternately first by the atria and then by the ventricles. With atrial fibrillation, the atrial muscles stop functioning simultaneously and contract in a chaotic manner, which causes irregular contraction of the ventricles. All this interferes with the normal functioning of the heart. Atrial fibrillation is primarily an “age-related” disease.

During the period of demographic aging of the population, atrial fibrillation has reached epidemic proportions, HSE experts indicate. However, unlike other cardiac diseases, it has received “surprisingly” little attention from Russian health authorities, the study authors say. Thus, in the federal project “Combating Cardiovascular Diseases” there is no special program to combat the development of arrhythmias. There are not even separate statistical records on the epidemiology of this disease. There are also no registers of patients suffering from heart rhythm disturbances, the HSE complains.

In 2019, the number of patients with atrial fibrillation in Russia was estimated at 2.5 million people. The development of a number of other cardiac pathologies is associated with this disease. The influence of ischemic stroke and atrial fibrillation leads to a 22% increase in the prevalence of stroke and a 38.9% increase in mortality due to it. The mutual influence of acute myocardial infarction and atrial fibrillation also increases the prevalence by 20% and mortality from infarction by 29.2%.

The leading risk factor for the development of atrial fibrillation is the patient’s age, experts indicate—on average, it debuts at 55 years of age. Other important factors include hypertension, body mass index, and alcohol consumption. The researchers emphasize that for Russia these risk factors are extremely significant, since their impact on the health of the population is much higher than in the world as a whole. In addition, HSE experts note that the coronavirus pandemic has had a serious negative impact. Due to patients who developed the disease after suffering from COVID-19, the prevalence of atrial fibrillation over three years potentially increased by 5%. The possible increase in patients with atrial fibrillation can be estimated at 41.7 thousand people. Researchers suggest that, taking into account the age structure of the incidence, the number of people with this diagnosis may increase by 601 thousand by 2036 compared to 2019 and amount to more than 3 million.

The development of arrhythmia especially affects the loss of working years among Russian men, the study says. Of the 312.6 thousand years lost in total due to arrhythmia, the working age (up to 65 years) accounts for 25%. Among them – 35.5% of all losses in men and 18% of losses in women (and in their case, 82% of losses occur after 65 years). The total loss due to atrial fibrillation in 2019 was 1,174,135.6 years. Of these, 864,552 were caused by associated diseases (ischemic stroke and myocardial infarction). The latter lead to a significant portion of deaths associated with arrhythmia.

The head of the research group, director of the Institute of Health Economics at the Higher School of Economics, Larisa Popovich, says that the implementation of the state program to combat cardiovascular diseases makes it possible to predict a decrease in mortality from this group of diseases, primarily from ischemic stroke. Despite this, we can expect an increase in economic losses from three associated diseases: atrial fibrillation, stroke and heart attack. The monetary equivalent of damage from them in terms of the statistical cost of a year of life in 2036 could amount to 962.1 billion rubles. (in terms of socially oriented expenses for human reproduction) or even 1566.6 billion rubles. (in terms of per capita GDP), the study authors warn. Compared to the amount of socio-economic damage in 2019, an increase of 1.7–1.8 times is possible. In this case, the damage will range from 0.5% to 0.8% of GDP, depending on assessment methods, the study says.

Larisa Popovich says that the problem of atrial fibrillation seemed completely unobvious. But when researchers began to understand it, it turned out that it is one of the key factors in determining the prognosis of development, including mortality, and is “simply underestimated.” Ms. Popovich said the next step is to understand how to prevent this damage. “For each such problem, it would be very correct for the Ministry of Health to evaluate the comparative effectiveness of this or that investment,” says the researcher. “It is then that they will begin to reason in the light of the investment process, which is very important for healthcare.”

The Russian Ministry of Health has not yet commented to Kommersant on the results of the study.

Cardiologist of the Doctis telemedicine service Albert Akhobekov believes that the HSE study is very important for a global understanding of the problem associated with atrial fibrillation. Improving existing prevention, diagnosis and treatment programs will help reduce the number of disabilities and mortality among the population, which will lead to a reduction in the socio-economic burden of arrhythmia.

Candidate of Medical Sciences, cardiologist Yaroslav Ashikhmin believes that the conclusions of the HSE experts are “absolutely realistic.” Moreover, the number of patients could potentially be higher, since a significant number of arrhythmia cases are undiagnosed. Accordingly, the economic burden from it will be higher. “The main cause of this arrhythmia is arterial hypertension, that is, an increase in blood pressure. The key danger is related to the risk of stroke,” explains the cardiologist. “The origins of the problem,” in his opinion, lie in poor blood pressure control in Russia: people pay little attention to their health and do not measure their blood pressure for years, especially men.

In addition, there are challenges related to healthcare system resources. For patients with suspected arrhythmia, 48-hour Holter ECG monitoring is indicated, but the number of devices and people who can decipher the result is very limited, says Mr. Ashikhmin: “That is, efforts must be made on two sides: on the one hand, telling people more about disease, and on the other hand, invest in new diagnostic algorithms, connect AI, and produce more domestic Holter monitors. We know how to do this.”

Natalia Kostarnova