Health Coverage – or Lack of it – Has Measureable Influence on Quality of Care and Outcomes for People With Heart Failure

Contact: Amanda Jekowsky,, 202-375-6645

For people hospitalized with new or worsening heart failure (HF), the type of health coverage one has – if any – can make a big difference when it comes to the quality of care received, as well as clinical outcomes.
In fact, compared to patients with private/HMO insurance, those with Medicaid, Medicare or no insurance have longer hospital stays and are less likely to receive some of the evidence-based therapies recommended for HF, according to a new study published in the September 27, 2011, issue of the Journal of the American College of Cardiology (JACC). Patients covered under Medicaid were also 22 percent more likely to die in-hospital.
“People often suspect that source of payment and public funding may be a risk factor for chronic illness and poor outcomes,” said Jack Lewin, MD, chief executive officer of the American College of Cardiology. “This study shows it’s not just opinion, but reality. It’s very concerning and critical for Medicaid, Medicare and policymakers to adopt more tools to help prevent HF complications and readmissions. It’s ethically unacceptable and unaffordable not to.”
Researchers analyzed data from nearly 100,000 patients hospitalized with HF at 244 sites participating in the Get with the Guidelines Heart Failure quality program between January 2005 and September 2009. They examined pre-specified HF performance and quality-of-care measures applied by the Centers for Medicare and Medicaid Services and the Joint Commission, additional quality indicators, length of hospital stay and in-hospital mortality by payment source.
Even among hospitals participating in a national HF quality improvement program, payment source appears to influence the implementation of guideline-endorsed HF therapy and outcomes.  In particular, patients with Medicaid or no health insurance were less likely to receive evidence-based beta blockers or implantable cardioverter-defibrillators (either placed or prescribed at discharge), among other appropriate therapies. Those covered through Medicaid and Medicare were less frequently prescribed angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and beta-blockers.
Based on their findings, authors say interventions to improve adherence to HF performance and quality-of-care measures to address these disparities are urgently warranted. They are also quick to caution that the observed associations may be partly explained by differences in socioeconomic status, which may influence patterns of care seeking, care delivery and clinical outcomes. However, as Dr. Lewin points out, these socioeconomic factors do not help to explain the decreased quality of care experienced under Medicare, which he says should be expected to offer comparable treatments to private/HMO coverage. 
Dr. Lewin further explains that hospitalization for HF can cost as much as $30,000 in complicated patients; something he suspects a few preventive nursing visits could have prevented in some cases. In addition, tracking patients in the inpatient and outpatient setting through registries and other programs like ACC’s Hospital to Home initiative (in partnership with the Institute for Healthcare Improvement) can help ensure quality of care to maximize outcomes early on.


The American College of Cardiology is transforming cardiovascular care and improving heart health through continuous quality improvement, patient-centered care, payment innovation and professionalism. The College is a 39,000-member nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers, and bestows credentials upon cardiovascular specialists who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at

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