Fewer cardiac arrests after Affordable Care Act expanded coverage

Featured image courtesy of Andrew Malone.

The United States has 350,000 cases of out-of-hospital cardiac arrest each year, a vast majority of them fatal. To determine how Oregon’s implementation of the Affordable Care Act, popularly known as “Obamacare,” impacted these devastating events, researchers crunched the numbers. A recent study in the Journal of the American Heart Association compared emergency medical care statistics for an urban county before and after the law went into effect. After the Affordable Care Act was implemented, incidence of cardiac arrest was 17 percent lower. We spoke with senior author Sumeet Chugh to learn more.Health insurance has an overall health benefit, but there is little information on major adverse events, such as sudden cardiac arrest. Lethal in nine out of ten patients who experience this condition, cardiac arrest is a human catastrophe that affects a 1,000 Americans a day.Expansion of health care insurance as a result of implementing the Affordable Care Act in Oregon significantly reduced the burden of sudden cardiac arrest (by 17 percent) among 45- to 64-year-old residents of Multnomah County. Such an effect was not observed in the over 65 age group, for whom coverage did not change.It’s likely multifactorial, possibly with a significant contribution from access to preventive health care enabled by the insurance expansion. At least 50 percent of this age group—both men and women—experience warning signs in the weeks that precede the sudden cardiac arrest event. While this would need to be specifically evaluated, it is possible that new access to health care encouraged some of these patients to see providers and receive treatments that prevented sudden cardiac arrest.By the time sudden cardiac arrest happens, it is lethal for the vast majority of patients. Therefore, only prevention will make a real impact. Our findings underline the important role of prevention in this regard, and more work is needed to tease out and focus on specific aspects that help the most.From these findings, we can only make conclusions regarding sudden cardiac arrest. However, it is possible that there is a broader impact.Two reasons. Firstly, an established research infrastructure devoted to the detailed study of sudden cardiac arrest. I founded this community-based evaluation in 2002, now ongoing for a decade and a half. It was originally underwritten by the US Centers for Disease Control and is currently funded by the National Heart, Lung, and Blood Institute. You could think of this research resource as analogous to the Framingham Heart Study, a long-term cardiovascular cohort study currently on it’s third generation of participants. Only we focus on finding novel ways of preventing sudden cardiac arrest, instead of other conditions such as coronary artery disease. Beyond that, the state of Oregon was an early adopter of the Affordable Care Act and so is uniquely suited for such an analysis based on timing.Based on our findings, we do. However, the same analysis would need to be performed in other states before we can say for sure.It’s difficult to say, since these appear to be a moving target, and because this study is a pilot study that needs to be confirmed in larger populations across other regions. One can speculate that loss of insurance expansion could potentially negate these effects. However, we hope that we will not have the opportunity to perform that study!