Medicaid expansion improves HF therapy administration for certain racial/ethnic groups
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The Affordable Care Act Medicaid Expansion increased receipt of ACE inhibitors, angiotensin II receptor antagonists and angiotensin receptor-neprilysin inhibitors for Hispanic patients hospitalized for HF, according to data presented at the virtual American Heart Association Quality of Care and Outcomes Research Scientific Sessions.
The Medicaid Expansion also increased the receipt of follow-up appointments for Asian patients after HF hospitalization, according to the abstract.
“The ACA Medicaid Expansion policy was associated with reduced racial and ethnic disparities, but the benefits were not widespread across all heart failure therapies,” Khadijah K. Breathett, MD, MS, FAHA, assistant professor of cardiology at the University of Arizona College of Medicine in Tucson, told Healio. “This raises the need for additional changes in health policy in order to meet the needs of our patient populations.”
Get With the Guidelines-HF registry
Researchers analyzed data from 271,606 patients (65.5% white, 22.8% black, 8.9% Hispanic, 2.9% Asian) from the Get With the Guidelines-HF registry. Among the cohort, 57.5% of patients were from early adopter states and 42.5% were from nonadopter states. Receipt of guideline-directed medical treatment, including ACE inhibitors, angiotensin receptor-neprilysin inhibitors, angiotensin II receptor antagonists, aldosterone antagonists, beta-blockers, HF education, hydralazine/nitrate and HF follow-up appointments, were compared before (2012-2013) and after the ACA Medicaid Expansion (2014-2019).
Receipt of ACE inhibitors, angiotensin II receptor antagonists and angiotensin receptor-neprilysin inhibitors at discharge increased in Hispanic patients after the implementation of the ACA Medicaid Expansion (OR = 2.46; 95% CI, 1.1-5.51) compared with before the expansion (OR = 0.4; 95% CI, 0.13-1.23; P for interaction < .01). This also increased the likelihood of HF follow-up appointments in Asian patients (OR before ACA Medicaid Expansion = 0.64; 95% CI, 0.2-2.06; OR after ACA Medicaid Expansion = 1.44; 95% CI, 0.5-4.15; P for interaction = .03). No other significant differences were observed regarding the receipt of guideline-directed medical treatment in other racial and ethnic groups at the time of the Medicaid expansion.
Hispanic patients who lived in early adopter states were more likely to receive all guideline-directed medical treatment compared with those who lived in nonadopter states independent of timing of the ACA (P < .01). Receipt of individual evidence-based treatments for other racial and ethnic groups varied by state group independent of timing.
Less than 60% of patients in both state groups received other guideline-directed medical treatments with the exception of ACE inhibitors, angiotensin receptor-neprilysin inhibitors and angiotensin II receptor antagonists despite eligibility.
“I would hope that health care professionals recognize the existing gaps in care and examine how to reduce disparities from multiple spheres of influence,” Breathett said in an interview. “Today, health care professionals can examine barriers within their individual practices, administrators can examine barriers from a center level and all of us must engage with policymakers to make sure that policy keeps up with the needs of the people.”
Implementation science research
Breathett said the next step is implementation science research. She told Healio: “Ideally, health care policy will be informed by research and titrated as needed to reach equity in health care access and outcomes. Implementation science research provides opportunity for real-time feedback loops that can lead to health equity. This requires an integrated collaboration between policymakers and health service researchers.” – by Darlene Dobkowski
Reference:
Breathett KK, et al. Presentations 22 and 384. Presented at: AHA Quality of Care and Outcomes Research Scientific Sessions; May 15-16, 2020 (virtual meeting).
Disclosure: Breathett reports she received research funding from the AHA, NHLBI and the University of Arizona Health Sciences.
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Breathett KK, et al. Presentations 22 and 384. Presented at: AHA Quality of Care and Outcomes Research Scientific Sessions; May 15-16, 2020 (virtual meeting).
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