Improved 3 Year Heart Transplant Survival in Black Recipients Following the Affordable Care Act

Area of Science:

• Cardiology
• Transplant Surgery
• Health Policy

Background:

• Healthcare access and inequities remain significant challenges in the US.
• Previous research indicated the Affordable Care Act (ACA) improved outcomes for Black transplant recipients.
• Racial disparities persist in heart transplant (HTx) access and outcomes.

Purpose of the Study:

• To evaluate the impact of the Affordable Care Act (ACA) on Black heart transplant (HTx) recipients.
• To analyze changes in HTx access, insurance effects on survival, geographic distribution, and survival rates among Black recipients pre- and post-ACA.

Main Methods:

• Analysis of 3,462 Black HTx recipients from the United Network for Organ Sharing (UNOS) database.
• Comparison of data from pre-ACA (Jan 2009-Dec 2012) and post-ACA (Jan 2014-Dec 2017) periods.
• Statistical analysis of recipient numbers, survival rates, insurance status, and geographic distribution.

Main Results:

• The proportion of Black HTx recipients significantly increased post-ACA (15.3% to 22.2%).
• Three-year survival rates improved significantly for Black recipients across multiple metrics (p < 0.01).
• ACA implementation was associated with improved survival (HR=0.64), and publicly insured patients achieved survival rates matching privately insured patients.

Conclusions:

• The Affordable Care Act (ACA) era demonstrated improved heart transplant (HTx) access and survival for Black recipients.
• National medical policies like the ACA can play a crucial role in mitigating racial disparities in organ transplantation.
• Continued efforts are necessary to address and eliminate inequities in medical care access and outcomes.