AHA QCOR: Medicaid Expansion Associated With Improved Heart Failure Prescribing for Hispanic Patients

Evidence that Medicaid expansion improves healthcare delivery and outcomes continues to accumulate.

At the American Heart Association Quality of Care and Outcome Research (QCOR) this weekend, Khadijah K. Breathett, M.D., M.S., FACC, FAHA, a health failure specialist and assistant professor at University of Arizona College Medicine, and her colleagues presented findings that showed Medicaid expansion was associated with improved prescribing of heart failure medications for Hispanic patients. 

Comparing patients in states that expanded Medicaid under the ACA relatively early on (“early adopters”) to patients in that states that didn’t expand Medicaid, Breathett and her co-investigator found that Hispanic heart failure patients in expansion states were 146% more likely to receive a prescription for heart failure medications when they were discharged from the hospittal than Hispanics in nonexpansion states.

The heart failure medications include ACE inhibitors (Altace, Lotensin, Monopril, other brands), ARBs (Avapro, Cozaar, Diovan, other brands),  and ARNIs (Entresto).

The University of Arizona researchers also found that Hispanics living in expansion state were more likely to receive all types of heart failure care, regardless of when the state expanded. 

Breathett and her colleagues looked at other patients in other minority groups. Asians  in expansion states were more likely to receive a follow-up appointment, but otherwise, they didn’t see Medicaid-associated changes in heart failure,

“Lack of insurance contributes to racial and ethnic health inequities among U.S heart failure patients,” Breathett said in a press release about her abstract, which was presented Friday at the virtual AHA QCOR meeting. “We are pleased to find that ACA Medicaid expansion was associated with increased delivery of cardiovascular care to racial and ethnic minority groups.”

Medicaid expansion has also been associated with differences in mortality. In June 2019 in the JAMA Cardiology, Sameed Ahmed M. Khatana, M.D., of the University of Pennsylvania, and his colleagues reported that, after accounting for demographic and other differences, counties in expansion states had 4.3 fewer deaths per 100, 000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states

At the upcoming  annual meetng of the American Society of Clinical Oncology, Anna Lee of the Memorial Sloan Kettering Cancer Center are reporting rlts that show a cancer mortality benefit from Medicaid expansion.