High-deductible health plans and major cardiovascular outcomes

July 24, 2020

(Boston, MA)-- In the first study to examine the association between high out-of-pocket costs and adverse cardiovascular events, research led by the Harvard Pilgrim Health Care Institute finds that individuals with cardiovascular disease risk factors who switched to high-deductible health plans (HDHPs) did not experience increased risk of heart attack or stroke. The study, "Association Between Switching to a High-deductible Health Plan and Major Cardiovascular Outcomes" appears in JAMA Network Open on July 24.

Cardiovascular disease kills more people in the U.S. than any other condition, accounting for 30% of deaths in 2017. Improvements in cardiovascular mortality began slowing a decade ago and major adverse cardiovascular events such as stroke and myocardial infarction began increasing among adults under age 65. Reasons for these trends are unclear, but experts have proposed causes such as the earlier onset of cardiovascular risk factors, stagnation of preventive care, and a change in health insurance coverage in the U.S. Concerns about the contribution of health insurance to these trends are based on the rapid expansion of HDHPs and previous research about health effects of high out-of-pocket costs.

The study team examined the effects of a transition to a HDHP on the risk of major adverse cardiovascular outcomes such as myocardial infarction and stroke. The study population, drawn from a large national health insurance plan, included individuals with risk factors for cardiovascular disease who were continuously enrolled in low-deductible (<$500) health plans during a baseline year followed by up to 4 years in high-deductible (?$1000) plans after an employer-mandated switch. The matched control group included individuals with the same risk factors who were contemporaneously enrolled in low-deductible plans. The researchers studied time to first major adverse cardiovascular event, defined as stroke or myocardial infarction.

Study findings show that HDHP members did not experience an increase in major adverse cardiovascular events compared with individuals in low-deductible plans. "Based on previous high-deductible health plan research, we had hypothesized that those with risk factors for cardiovascular disease would experience increases in major adverse cardiovascular events after a switch to high-deductible health plans, but this did not turn out to be the case," said Frank Wharam, lead author and Associate Professor of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School. Dr. Wharam adds, "HDHPs typically include features such as low or no out-of-pocket costs for medications and preventive services. Our study detected small changes in cardiovascular medication use and preventive services which may have protected HDHP members from increased adverse cardiovascular events.

These findings provide a measure of reassurance that HDHP enrollment was not associated with an appreciable increased risk of major adverse cardiovascular outcomes. But researchers caution that policymakers and employers should remain careful in promoting HDHPs among low-income and other vulnerable patients given the potential for adverse financial and health outcomes that this study did not address. Research should also extend follow up time to better assess long-term outcomes and should examine whether people with HDHPs ultimately require more intensive workups and more advanced treatments for cardiovascular events.

The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and teaching.

Harvard Pilgrim Health Care Institute

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.