The Deadly Cost of Heart Disease: Filipino Families Grapple with Economic and Emotional Toll

In the Philippines, heart attacks and strokes are not just medical emergencies; they are life-altering events that strike at the core of family life, leaving behind a trail of emotional devastation and crippling financial burdens. As the leading causes of death in the country, these conditions—rooted in atherosclerotic cardiovascular disease (ASCVD)—continue to claim tens of thousands of lives each year while imposing staggering costs on survivors and their loved ones. Beyond the physical toll, the economic strain and mental health challenges paint a grim picture of a public health crisis that demands urgent attention.

A Leading Cause of Death with a Heavy Price

Heart attacks and strokes, consequences of ASCVD, are driven by the gradual buildup of plaque in arteries—a process known as atherosclerosis. This narrowing of blood vessels restricts oxygen flow to vital organs, heightening the risk of life-threatening conditions like coronary heart disease (CHD) and cerebrovascular disease, commonly known as stroke. According to recent data, ischaemic heart disease, a form of CHD, was the top cause of death in the Philippines in early 2024, accounting for nearly 50,000 fatalities. Stroke followed closely as the third leading cause, claiming over 25,000 lives in the same period.

While the mortality rates are staggering, survival often comes at a steep cost. ASCVD survivors frequently endure long-term emotional and psychological scars, compounded by the financial strain of medical treatment and lost income. Dr. Janet Chavez, a medical advisor at Novartis Healthcare Philippines, notes that these events “do not always end in death” but can profoundly impact a patient’s life for years. For many Filipino families, the aftermath of a heart attack or stroke becomes a battle on multiple fronts—physical recovery, mental resilience, and economic survival.

The Crushing Economic Burden

The financial toll of ASCVD is staggering, often pushing families into debt or poverty. A leading Filipino insurance company estimates that managing an acute heart attack can cost up to P1 million (approximately £14,000) over the first decade, covering hospitalisation, medication, and follow-up care. For stroke patients, the economic burden is equally severe. Research by neurologist Dr. Jose Navarro and colleagues suggests that stroke care in the Philippines, largely privatised, forces patients and families to bear most expenses out of pocket, with total costs for the half-million affected Filipinos ranging between $350 million and $1.2 billion (P19.6 billion to P67.3 billion).

The Philippine Health Insurance Corporation (PhilHealth) offers limited relief, covering only P28,000 for ischaemic stroke and P38,000 for haemorrhagic stroke—amounts that pale in comparison to actual treatment costs. A survey by the Stroke Society of the Philippines found that thrombolysis for acute ischaemic stroke in private hospitals can cost between P136,688 and P228,678, while even in government hospitals, costs range from P3,239 to P35,903. For more complex cases, hospitalisation expenses at public tertiary hospitals can climb as high as P95,693.50, a sum that could equate to several months of income for the average Filipino family, which earns about P313,000 annually.

Dr. Maria Epifania Collantes, co-author of a study on stroke care in the Philippines, highlights the catastrophic impact on lower-income households. “The expenses incurred in private hospitals alone can cost several months of salary,” she warns, underscoring how such costs can devastate families already struggling to make ends meet. For many, these medical bills do not account for additional losses, such as income foregone due to an inability to work during recovery.

Personal stories bring these statistics to life. Joel, a 59-year-old development consultant and stroke survivor from Malolos, Bulacan, recounts spending P36,000 for a five-day hospital stay in October 2024, even after PhilHealth discounts. Fortunately, his ongoing projects provided some financial stability, but others are not so lucky. Another survivor, using the pseudonym Noah, shared in a Facebook group for Filipino stroke survivors how he was forced to resign from work due to physical limitations post-stroke, including slurred speech and difficulty walking. “I used to work, but I had to leave,” he said, reflecting a common struggle among survivors facing both health challenges and economic hardship.

Emotional and Psychological Scars

Beyond the balance sheet, the emotional and mental health toll of ASCVD is profound. Survivors often grapple with anxiety, depression, and a diminished sense of self-worth as they navigate recovery. The invisible scars of these conditions can linger for years, affecting not just patients but also their families, who bear the burden of caregiving and emotional support. Noah’s story offers a glimpse of hope amidst the struggle; with his wife’s support, he has worked to reclaim a semblance of normalcy, resuming daily tasks like driving and household chores. “Just keep going—we learn from our experiences,” he advises, embodying resilience in the face of adversity.

Health experts stress that the psychological impact is often underestimated. The fear of a second event, which can be more life-threatening and costly, adds another layer of stress. Dr. Marc Del Rosario, head of the Cardiac Catheterization Laboratory at the Asian Hospital and Medical Center, emphasises the importance of preventing recurrence. “Preventing the second event is not just clinically helpful but also cost-effective,” he says, pointing to a critical gap in public awareness and healthcare strategy.

## A Silent Threat Rooted in Lifestyle and Genetics

ASCVD does not strike overnight. As Dr. Del Rosario explains, atherosclerosis is a slow, progressive disease that can begin in childhood and span decades before manifesting as a heart attack or stroke. “People think this happens overnight… that couldn’t be farther from the truth,” he says, dispelling myths about the sudden onset of the condition. Instead, it is the culmination of years of risk factors—some unchangeable, like family history and genetics, and others tied to lifestyle choices, such as diet, smoking, and physical inactivity.

Modifiable risk factors, particularly hypertension (high blood pressure) and unhealthy diets, are leading contributors to ASCVD in the Philippines, according to local data from the Department of Health. Hypertension, often dubbed a “silent killer” due to its lack of symptoms, can damage blood vessels over years without detection unless regularly monitored. Similarly, hypercholesterolemia—high levels of “bad” cholesterol (LDL)—affects one in 20 people globally and significantly raises the risk of severe atherosclerosis, yet often goes undiagnosed until a major event occurs.

Joel’s experience illustrates how lifestyle plays a role. Despite avoiding fatty and salty foods, his history of smoking and drinking likely contributed to his stroke. “I was a drinker and smoker. Thus, the stroke,” he admits, reflecting on choices that compounded his risk alongside pre-existing hypertension. Experts like Dr. Debora David Ona, president of the Philippine Lipid and Atherosclerosis Society, urge Filipinos to address these modifiable factors through healthier diets, regular exercise, and routine health screenings—simple steps that could prevent countless tragedies.

A Call for Risk-Based Healthcare

The scale of the ASCVD crisis in the Philippines underscores the need for a shift from reactive, crisis-based care to proactive, risk-based prevention. Dr. Del Rosario advocates for regular check-ups and community health screenings, such as annual physical exams and barangay-level initiatives, to catch silent conditions like hypertension and high cholesterol early. “Even if you don’t feel anything, you might already be sick,” he cautions, highlighting the importance of awareness and early intervention.

Yet, systemic challenges remain. Limited public health funding, inadequate insurance coverage, and the high cost of privatised care create barriers to effective prevention and treatment. For lower-income families, the economic fallout of a heart attack or stroke can be catastrophic, exacerbating cycles of poverty and inequality. Without broader access to affordable healthcare and education on risk factors, the deadly grip of cardiovascular disease will continue to tighten around Filipino families.

The burden of ASCVD in the Philippines is a multifaceted crisis—medical, emotional, and economic—that demands a collective response. Survivors like Joel and Noah demonstrate remarkable resilience, but their stories also reveal the urgent need for systemic change. Enhancing PhilHealth coverage, expanding public health initiatives, and raising awareness of modifiable risk factors could save lives and alleviate the financial strain on families.

As the country grapples with this silent epidemic, the message from health experts is clear: know your risks, monitor your health, and act before it’s too late. For now, thousands of Filipino families continue to bear the heavy cost of heart disease and stroke, hoping for a future where no heart is lost too soon.