Medicaid-insured heart transplant patients face higher risk of post-transplant complications

(Press-News.org) A new study led by UCLA Health highlights the link between socioeconomic disadvantage, Medicaid insurance, and poorer survival rates after heart transplantation. Researchers found that Medicaid-insured heart transplant patients had a higher likelihood of developing cardiac allograft vasculopathy (CAV), a condition that affects transplanted hearts and can limit long-term survival. It has been reported that CAV contributes to more than 30% of all deaths in the first 5 to 10 years following heart transplantation. 

The study, which included heart transplant recipients aged 18 and older, divided into Medicaid and Non-Medicaid cohorts, and pre-and post-Affordable Care Act (ACA) eras, found that Medicaid-insured patients had a higher likelihood of developing CAV over 5 years, with worse survival rates, particularly in the post-ACA era. It is published in The Annals of Thoracic Surgery and will be presented on Saturday at the Plenary Session of The Society of Thoracic Surgeons (STS) annual meeting as the top paper in perioperative and critical care.

“CAV is a leading cause of morbidity and mortality following heart transplant. Our work demonstrates that socioeconomic disadvantage influences the risk of CAV in the months and years following this life-saving operation,” said Sara Sakowitz, a medical student at the David Geffen School of Medicine at UCLA and first author of the study. “Although the ACA has expanded access to heart transplantation for previously uninsured patients, significant barriers to accessing longitudinal post-transplant treatment, affordable medications, and equitable, high-quality care remain.” 

Notably, the study found that the risk of developing CAV was mitigated with treatment at high-volume transplant centers. While Medicaid patients at non-high-volume centers had a significantly higher risk of developing CAV, at high-volume centers the risk for Medicaid patients was similar to those who were not on Medicaid.

Several factors contribute to why patients at high-volume transplant centers fared better. “Patients treated at high-volume transplant centers often benefit from specialized expertise, comprehensive care, and robust patient support systems,” said Peyman Benharash, a cardiothoracic surgeon at UCLA Health, director of the ECMO program and corresponding author of the study.

“These centers are equipped with dedicated teams and streamlined protocols that ensure consistent follow-up and access to essential medications, significantly improving post-transplant outcomes and survival rates." 

Article: Insurance-Based Disparities in Cardiac Allograft Vasculopathy Following Heart Transplantation Are Mediated by Care at High Volume Centers; The Annals of Thoracic Surgery, ANNALS-24-01665R1 

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