Can Healthcare Expansion Rapidly Reduce Out‐of‐Hospital Cardiac Arrest?

Sudden, out‐of‐hospital cardiac arrest (OHCA) is a major health problem that occurs in an estimated 347 322 adults in the United States annually, with an incidence of 140.7 per 100 000 population. With overall survival averaging as low as 8% to 12% in many parts of the country, OHCA results in an estimated 2 million years of potential male lives lost and 1.3 million years of potential female lives lost. Prevention of this significant cause of premature death has the potential to save many lives every year. In this issue of JAHA, Stecker and colleagues performed a pre–post pilot study before and after Medicaid expansion in Multnomah County, Oregon, and documented an astonishing 17% decrease in the incidence of OHCA of primary cardiac etiology in middle‐aged adults (aged 45–60 years) within 2 years of the rapid, community‐wide expansion of health insurance (Medicaid) coverage. This coverage expanded as part of the Affordable Care Act (ACA). During the same time period, there was no change in the incidence of OHCA in the elderly population (aged ≥65 years), a group with near‐universal healthcare coverage under Medicare that was unchanged by the ACA.