ESTIMATING CLINICAL MORBIDITY DUE TO ISCHEMIC-HEART-DISEASE AND CONGESTIVE-HEART-FAILURE - THE FUTURE RISE OF HEART-FAILURE

Objectives. Many developed countries have seen declining mortality rat es for heart disease, together with an alleged decline in incidence an d a seemingly paradoxical increase in health care demands. This paper presents a model for forecasting the plausible evolution of heart dise ase morbidity. Methods. The simulation model combines data from differ ent sources. It generates acute coronary event and mortality rates fro m published data on incidences, recurrences, and lethalities of differ ent heart disease conditions and interventions. Forecasts are based on plausible scenarios for declining incidence and increasing survival. Results. Mortality is postponed more than incidence. Prevalence rates of morbidity will decrease among the young and middle-aged but increas e among the elderly. As the milder disease states act as risk factors for the more severe states, effects will culminate in the most severe disease states with a disproportionate increase in older people. Concl usions. Increasing health care needs in the face of declining mortalit y rates are no contradiction, but reflect a tradeoff of mortality for morbidity. The aging of the population will accentuate this morbidity increase.