Access to Care - State Issues

The American Heart Association aims to reduce cardiovascular disease among all Americans regardless of age, race, ethnicity, or socioeconomic status. The American Heart Association advocates for:

Newborn Screening
In 2010, Critical Congenital Heart Disease (CCHD) accounted for 27% of infant deaths that are caused by birth defects (1). Routine prenatal ultrasounds detect less than 50% of these defects and physical exams after birth are not sufficient to diagnose all cases of CCHD (2). Pulse oximetry screening is a low-cost, non-invasive, and painless bedside diagnostic test that can be completed by a technician in as little as 45 seconds at an estimated cost of less than $4 per infant (2, 3). Research suggests that when used in conjunction with the routine practices, pulse oximetry is effective in over 90% of newborns (4). To identify CCHD as early as possible, the American Heart Association advocates for:

  • State adoption of mandatory CCHD screening using pulse oximetry for all newborns.
  • Collection of screening data for continuous quality improvement.

Preventive Benefits in Medicaid
Cardiovascular damage can start early in life and is influenced over time by lifestyle behaviors, the environments where people live, and modifiable risk factors (smoking, overweight and obesity, unhealthy diet, physical inactivity, high blood pressure, elevated blood cholesterol, and Type 2 diabetes). Men and women who lower their risk factors may have 79-82% fewer heart attacks and strokes than those who do not reduce their risk factors (5, 6). To help all Americans reduce these risk factors, the American Heart Association advocates for:

  • Coverage of preventive benefits in private and public health insurance plans.
  • State inclusion of USPSTF A and B benefits related to cardiovascular disease (CVD) under Medicaid without cost sharing.

Tobacco Cessation Coverage
Available forms of nicotine replacement therapy increases a person's ability to quit successfully by 50-100% compared with not using any of these products at all. However, fewer than 20% of smokers making a quit attempt use these therapies (7). Two years after Massachusetts began offering tobacco cessation benefits to Medicaid recipients, the smoking rate declined from 38% to 28% and hospitalizations for heart attacks dropped by 38% (8). To help smokers take advantage of these effective therapies, the American Heart Association advocates for:

  • Comprehensive coverage of tobacco cessation services by private and public health insurers for all current tobacco users including counseling and pharmacotherapy.
  • No cost sharing.

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1 – Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292
2 – Mahle WT, Newburger JW, Matherne GP, et al. Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement From the American Heart Association and American Academy of Pediatrics. Circulation. 2009;120(5):447-458.
3 – Peterson C, Grosse SD, Cassell CH, Oster ME, Olney RS. Abstract 228: A Cost-effectiveness Analysis of Universal Pulse Oximetry Screening to Detect Critical Congenital Heart Disease in U.S. Newborns. Circ Cardiovasc Qual Outcomes. 2012;5:A228.
4 – de-Wahl Granelli A, Wennergren M, Sandberg K, et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns. BMJ. 2009;338(jan08 2):a3037-a3037.
5 - Stampfer M.Hu FB, et al., Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343:16-22.
6 - Gorelick PB. Primary prevention of stroke: Impact of healthy lifestyle. Circulation. 2008;118:904-906.
7 - Cummings KM, Hyland A. Impact of nicotine replacement therapy on smoking behavior. Annu Rev Public Health. 2005;26:583-599.
8 - Land T, Warner D, Paskowsky M, Cammaerts A, Wetherell L, et al. Medicaid Coverage for Tobacc Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence. PLoS ONE. 2010;5(3): e9770. doi:10.137/journal.pone.0009770.