JACC In a Flash

JACC: Heart Failure
Study Finds Adopting ACA Medicaid Expansion Increased Heart Transplant Listings in African-Americans

Cardiology Magazine, Jan. 2017The implementation of the Affordable Care Act (ACA) Medicaid Expansion was associated with increased heart transplant listings in African-Americans, according to a study published Jan. 18 in JACC: Heart Failure.

Using the Scientific Registry of Transplant Recipients, Khadijah Breathett, MD, et al., analyzed 5,651 patients from early adopter, states that implemented the expansion by Jan. 2014, and 4,769 patients from non-adopter states from 2012 to 2015. Piecewise linear models, stratified by race and ethnicity, were fit to monthly census-adjusted rates of heart transplant listings before and after Jan. 2014.

The authors observed a 30 percent increase in the rate of heart transplant listings for African-Americans immediately following ACA Medicaid Expansion in early adopter states. In contrast, the rate of heart transplant listings for African-Americans in non-adopter states remained constant. The authors also found that Hispanics experienced an opposite trend, with the rates showing no significant change in early adopter states but an increase in non-adopter states. There were no significant changes in listing rates among Caucasians in either early adopter or non-adopter states.

According to the authors, the findings suggest that improved access to insurance may be a partial solution to reducing racial and ethnic disparities in organ allocation in the U.S.

“Because the number of donor hearts is limited, it is critical that different racial and ethnic groups have equitable access to this scarce resource,” said Breathett. “In some states, patients with basic health care coverage like Medicaid may not be given equitable candidacy as patients with Medicare and private insurance since Medicaid programs will not universally cover costs of transplantation. It is paramount to avoid increasing racial/ethnic disparities as the selection process is calibrated particularly among politically divided Organ Procurement Organizations.”

In an accompanying editorial, Marvin A. Konstam, MD, FACC, suggests that this progress towards eliminating disparity in heart transplant allocation should not be abandoned. He explains that, “If we achieve consensus around our core goals, then there is no escaping a role of government in subsidizing health care for our least fortunate citizens, but beyond this fact, there are other legitimate choices to make: the relative roles of the private vs. public sectors; service-based vs. value- and population-based payment models; and payer focused vs. provider- and patient-focused decision making and risk bearing.” Konstam concludes with this sentiment, “Let us hope that as this next round of the debate unfolds, it focuses less on the name of the act and more on serving the health care needs of our entire population.”


Breathett K, Allen LA, Helmkamp L, et al. JACC Heart Fail 2017;Jan 18:[Epub ahead of print].

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Heart Transplant, Interventions and Vascular Medicine, Hypertension, Smoking

Keywords: ACC Publications, Cardiology Magazine, Alcoholism, Ambulatory Surgical Procedures, Antibodies, Monoclonal, Aspirin, Atrial Fibrillation, Cardiovascular System, Cholesterol, LDL, Consensus, Continuity of Patient Care, Diabetes Mellitus, Drug Costs, Ethnic Groups, Headache, Health Literacy, Heart Failure, Heart Transplantation, Hispanic Americans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Intercellular Signaling Peptides and Proteins, Medicaid, Medicare, Medication Adherence, Myocardial Infarction, Nausea, Nervous System Diseases, Obesity, Patient Protection and Affordable Care Act, Risk Factors, Smoking, Stroke Volume, Thromboxane B2, Tissue and Organ Procurement, United States Food and Drug Administration, Amygdala, Angina Pectoris, Antihypertensive Agents, Anxiety, Arteries, Biomedical Technology, Body Mass Index, Bone Marrow, C-Reactive Protein, Confidence Intervals, Cross-Sectional Studies, Diuretics, Follow-Up Studies, Health Surveys, Hematoma, Hypertension, Inflammation, Medically Uninsured, Myocardial Infarction, Neoplasms, Peripheral Arterial Disease, Risk Factors, Stress Disorders, Post-Traumatic, Stroke


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