December 04, 2017
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CV health screenings rose after implementation of ACA

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Joseph Ladapo
Joseph A. Ladapo

Screenings for certain CV risk factors, including diabetes, smoking and high BP, increased after the Affordable Care Act was implemented, according to an analysis published in The American Journal of Managed Care.

However, the researchers found men were more likely than women to use aspirin as preventive therapy.

“Our study shows that Affordable Care Act provisions that make it less expensive out-of-pocket for people to receive preventive cardiovascular care were effective in increasing screening for diabetes, smoking and hypertension,” Joseph A. Ladapo, MD, PhD, associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, told Cardiology Today. “It’s important to the public because it provides people with more information to make a judgement about the value of the ACA. All of these preventive cardiovascular services that increased in frequency are recommended by the U.S. Preventive Services Task Force, so they all improve population health. The hypertension finding is especially relevant since the American College of Cardiology and American Heart Association just changed the definition of hypertension for the first time in 14 years; now the cutoff is 130 mm Hg/80 mm Hg instead of 140 mm Hg/90 mm Hg.”

Ladapo and Dave A. Chokshi, MD, MSc, FACP, chief population health officer of OneCity Health, senior assistant vice president at New York City Health and Hospitals and clinical associate professor of population health and medicine at the NYU School of Medicine, conducted an analysis using a difference-in-differences approach to examine the impact of the ACA on preventive cardiology care, measuring changes in an outcome in policy change while accounting for a control group not affected by the change.

The researchers analyzed data between 2006 and 2013, comparing use of preventive serviced before the ACA was implemented in 2010 vs. after.

Compared with before implementation, the period after implementation had increased use of the following measures:

  • diabetes screening: 2006-2010, 3.9%; 2010-2013, 7.6%; difference in differences, 3.5 per 100 visits; 95% CI, 1.1-5.9;
  • tobacco use screening in adults: 2006-2010, 64.4%; 2010-2013, 74.5%; difference in differences, 11.6 per 100 visits; 95% CI, 4.8-18.3;
  • aspirin therapy in men: 2006-2010, 11.1%; 2010-2013, 13.5%; difference in differences, 2.9 per 100 visits; 95% CI, 1.1-4.6; and
  • hypertension screening: 2006-2010, 73.2%; 2010-2013, 76.4%; difference in differences, 9.9 per 100 visits; 95% CI, 2.8-16.9.

There were no significant changes from before to after ACA implementation in obesity treatment, cholesterol screening in men or women, aspirin therapy in women, tobacco use screening in pregnant women, smoking cessation advice in pregnant smokers or smoking cessation advice in adult smokers, Ladapo and Chokshi wrote.

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“Our study shows that screening went up because of an ACA provision that specifically reduced how much patients had to pay out-of-pocket for cardiovascular screening,” Ladapo said. “We don’t know whether this is because physicians changed their behavior or because patients requested more care, but screening did increase. We can expect to see a reduction in evidence-based preventive cardiovascular care if this type of provision is weakened or repealed. It is important to note, though, that there are other policy approaches for improving cardiovascular care outside of the ACA. The problem is that U.S. health policy is very difficult to change, so I doubt anything helpful would sprout up in its place if this provision was weakened.”

The difference between use of aspirin therapy in men vs. women may be due to a perception by some clinicians that heart disease is more likely to affect men, Ladapo said.

“We do know that it is not grounded in evidence because we limited the female population to a specific age category for which aspirin has been demonstrated to reduce cardiovascular events,” Ladapo told Cardiology Today. “I think that, even though CVD is the leading cause of death among women, there is often a perception among both laypersons and some doctors that heart disease is more of a ‘man’s disease’ than something that claims the lives of women.” – by Erik Swain

For more information:

Joseph A. Ladapo, MD, PhD, can be reached at David Geffen School of Medicine at UCLA,

911 Broxton Ave., Los Angeles, CA 90024; email: jladapo@mednet.ucla.edu.

Disclosure: Ladapo reports that the work was supported by a K23 Career Development Award from the NHLBI and grants from the National Institute on Minority Health and Health Disparities and the Robert Wood Johnson Foundation.