Out-of-hospital cardiac arrests fell under the Affordable Care Act

(Reuters Health) - In Oregon, the rate of cardiac arrests happening outside of hospitals fell significantly after implementation of the Affordable Care Act and its expansion of health insurance coverage, researchers report.

“The degree of benefit was most surprising: a 17 percent reduction in risk of cardiac arrest (a life-threatening condition where the heart stops pumping) among the middle-aged population for whom health insurance was expanded,” lead author Dr. Eric C. Stecker from Oregon Health and Science University (OHSU) in Portland said by email.

Health insurance plays a big role in how, and whether, people receive adequate healthcare, but it’s not clear that better health insurance is associated with a lower risk of major bad health outcomes.

Stecker and his colleagues studied the rate of out-of-hospital cardiac arrests before and after a rapid, community-wide expansion of health insurance coverage as part of the Affordable Care Act, also known as Obamacare.

Rates of uninsurance among middle-aged adults decreased by roughly half after implementation of the law, while rates of uninsurance remained steady and very low among the elderly, according to the report in the Journal of the American Heart Association.

From 2011-2012, before the Affordable Care Act went into effect, to 2014-2015, after its implementation, Medicaid coverage increased from 7 percent of the middle-aged population to 13.5 percent and direct-purchase insurance coverage rose from 8.2 percent to 10 percent. Employer-sponsored insurance rates in this group didn’t change.

Among 45 to 64-year-olds, the rate of out-of-hospital cardiac arrests fell by 17 percent after the expansion of health insurance.

“Our study reinforces prior studies that have shown improvements in preventive care and a decrease in death rates after insurance was made available to people who had been uninsured,” Stecker said.

“I can’t speak for OHSU, but my personal opinion is that lawmakers and voters should carefully consider the proposed healthcare legislation and understand that if it results in more people being uninsured, it may lead to more preventable deaths,” he said. “Both the House and Senate versions would, over time, significantly increase the number of Americans without health insurance.”

Sudden cardiac arrest is responsible for approximately 350,000 deaths in the U.S. each year, more than any individual disease, Stecker noted. “But it is hard to prevent because most people are not aware they are at risk. This pilot study showed that Medicaid expansion may reduce the number of cardiac arrests. Further research is needed to understand any other factors that could be involved.”

There are many important factors that contribute to cardiovascular health, he added. “Healthy diet, regular exercise and not smoking are critical in the long run. But that alone is not enough. It is also important to have access to health care to evaluate concerning symptoms, access preventive care and be able to afford the medications that have been proven to prevent death and improve overall wellbeing.”

Mary Fran Hazinski from Vanderbilt University School of Nursing in Nashville, Tennessee, told Reuters Health it’s important to note that Oregon’s significant decrease in out-of-hospital cardiac arrest (OHCA) occurred in a state that not only provided expanded Medicaid coverage, but also completed extensive healthcare payment and delivery innovation.

This included establishing patient-centered primary care “homes” (consistent primary care physicians) with “an integrated system of regional coordinated care organizations that were required to follow evidence-based guidelines and monitor quality of care and cost-effectiveness),” said Hazinski, who coauthored an editorial accompanying the new study.

Extrapolating from Stecker’s team’s results, Hazinski said, the elimination of healthcare coverage for 22 million people projected to result from the healthcare bill under consideration in the U.S. Senate would produce an estimated additional 3,740 deaths from OHCA annually.

“Healthcare coverage, alone, is not a panacea,” she added. “However, expanded healthcare coverage can save lives when provided in a system that promotes best practices and carefully monitors quality and costs. Conversely, elimination of healthcare coverage is likely to result in lost lives as well as delayed healthcare and, therefore, increased cost of care.”

SOURCE: Journal of the American Heart Association, online June 28, 2017.