Research
Our Research
The Health Care Policy Section largely investigates the impact of state and federal health policy initiatives, such as policies on insurance coverage, quality improvement, and value-based delivery reform, on cardiovascular health care and outcomes. Other major areas of investigation have been looking at prescription drug policy, particularly in relation to the Inflation Reduction Act, as it relates to health care access and medication adherence, and the associated health outcomes, and the growing presence of private equity in health care, and increasingly so in cardiology, which work from our group has indicated may be worse for patient care, with little benefit for health outcomes. Our team works primarily with large national datasets such as Centers for Medicare and Medicaid claims, the National Health and Nutrition Examination Survey, the National Health Interview Survey, the Medical Expenditure Panel Survey, and the Behavioral Risk Factor Surveillance System, among others.
Research Funding
Strategies to Improve the Cardiovascular Health of Rural Working-Age Adults in the United States September 2024 - May 2028
NHLBI, NIH; R01
Principal Investigator: Rishi K. Wadhera
In this grant, we examine changes in access to care and the prevalence of CV 
risk factors, hospitalizations, and mortality in rural working-age adults post- pandemic, determine the effects of expanding Medicare on health care access, screening for CV risk factors, and the treatment & control of CV risk factors in rural working-age adults, and we will create a new, multidimensional data-source to evaluate if access to medical care, including telemedicine use in the outpatient and hospital settings, and CV outcomes improve in rural communities that expand broadband access. As a result of work on this grant, we have found that rural-urban differences in cardiovascular mortality widened from 2010 to 2022, particularly among young adults. These differences were more pronounced during the pandemic, with rural areas experiencing greater interruptions in coverage, access, and affordability of health care, as well as a disproportionate increase in substance use, depression, and suicidality, all which likely play a role in the increased risk of cardiovascular mortality. These findings have been published in JACC. Building off of these findings, we have also published work in JAMA Cardiology, where we found rural-urban disparities in cardiometabolic risk factors and cardiovascular disease, once again seen particularly among young adults. These disparities could be almost entirely explained be social risk factors such as poverty, education level, food insecurity, and home ownership.
Leveraging SNAP Policies to Improve the Cardiovascular Health of Low-Income Adults in the United States July 2024 - June 2028
NINR, NIH; R01
Principal Investigator: Rishi K. Wadhera
The main goals of this project are to determine changes in food insecurity in low- 
income adults and the impact of ending Supplemental Nutrition Assistance Program (SNAP) emergency allotment policies, which were enacted during the pandemic. Our research to date has consisted of using causal inference methods to demonstrate that the major reduction in SNAP benefits caused by the ending of emergency allotments led to an increase in poor physical health. These findings have been published in JAMA and presented at the AcademyHealth 2025 Annual Research Meeting.
Cardiovascular Health of Low-Income Working-Age Adults in the US: July 2022 - June 2027
Health Care Access, Policy, and the Pandemic
NHLBI, NIH; R01
Principal Investigator: Rishi K. Wadhera
This project aims to examine the epidemiology of cardiovascular risk factors, disease, and outcomes in low-income working-age adults (18 to 64 years) and evaluate the pandemic’s impact on health care access and affordability as well as cardiovascular morbidity and mortality. Three years into this research, we have seen lifetime risks for cardiovascular disease increase through our findings that while the prevalence of adults with diabetes did not significantly change between 2013 and 2023, glycemic control among those diagnosed with diabetes worsened in 2021-2023, and HbA1c levels increased (JAMA), and that there has been an increasing prevalence of hypertension, diabetes, and obesity, while treatment and control rates remain suboptimal (JAMA) and there has been no significant improvement in awareness of these conditions, and awareness of hypertension decreased (JAMA Cardiology). Our findings have been concentrated among young, working-age adults. We have also analyzed how income-based inequities in cardiovascular mortality, and the prevalence, treatment, and control of cardiovascular risk factors have changed between low-income and higher-income adults (Annals of Internal Medicine) over the past decade, and in a separate analysis, found that the burden of acute cardiovascular events (myocardial infarction, stroke) is increasing among middle-aged adults in the United States (European Heart Journal). We have also utilized large, national datasets to analyze the effects of the pandemic on changes in health care overage, access, and affordability, self-reported health, and cardiovascular morbidity and mortality in low-income working-age adults (American Journal of Preventive Medicine; PLOS Medicine; JAMA Cardiology; Circulation CQO; JAMA Health Forum)
The Inflation Reduction Act and Cardiovascular Health: April 2024 - March 2029
Access, Adherence, and Pharmacoequity
AHA Established Investigator Award
Principal Investigator: Rishi K. Wadhera
The Inflation Reduction Act was signed into law in 2022, and has four major provisions 
that could greatly influence access to cardiovascular medication, and, in turn, cardiovascular health for Medicare beneficiaries. The project aims to determine the effect of the Inflation Reduction Act (IRA) on out-of-pocket costs for prescription drugs that treat cardiometabolic risk factors and conditions, evaluate whether the IRA leads to changes in cardiometabolic risk factors and cardiovascular conditions, and to determine the implications of this act on socially vulnerable populations. Through this project, our study team has published manuscripts evaluating the IRA and out-of-pocket spendings (Journal of General Internal Medicine), including our findings that the IRA will save 1.2 million Medicare beneficiaries $2.1 billion in health care spending (presented at AcademyHealth Annual Research Meeting 2024). We have also studied the impact of the IRA on Medicare beneficiaries with asthma and COPD, finding that total annual savings would be $504 million (Journal of General Internal Medicine). Asthma and COPD are two of the most common conditions among Medicare beneficiaries that are also associated with significant drug spending and high rates of cost-related nonadherence to medications.
Accountable Care Organizations in Medicaid: Reducing Low-Value Care for Working-Age Adults January 2024 - December 2025
Donaghue Greater Value Portfolio Grant
Principal Investigator: Rishi K. Wadhera 
The main goal of this project is to evaluate how the implementation of Medicaid Accountable Care Organizations (ACOs) in Massachusetts impacted the receipt of low-value health care services for working-age adults enrolled in Medicaid, both overall and across key subgroups. In the first of our studies related to this grant, we have evaluated the impact of Medicaid ACOs on high value cardiometabolic care delivery in Massachusetts. Findings were presented at AcademyHealth Annual Research Meeting 2025.
Mentorships
Evaluating Policies to Improve Heart Failure Outcomes in Medicare July 2024 - June 2029
NHLBI, NIH; K23
PI: Andrew S. Oseran
Primary Mentor: Rishi K. Wadhera
Impact of the Inflation Reduction Act on Racial and Ethnic Disparities in Asthma/COPD July 2025 - June 2027
American Lung Association Paul Billings Public Health and Public Policy Research Award
PI: Stephen A. Mein
Primary Mentor: Rishi K. Wadhera
Diagnostic Equity in Heart Failure: Identifying Opportunities for Earlier Diagnosis to Reduce Disparities in Care April 2025 - March 2028
AHA Career Development Award
PI: Lucy Schulson
Mentor: Rishi K. Wadhera
Strategies to Improve the Cardiovascular Health of Low-Income Adults with Obesity in the US
John S. LaDue Memorial Research Fellowship
PI: Lucas Marinacci
Mentor: Rishi K. Wadhera
Explaining Rising Heart Failure Mortality in the Medicare Population 2019 - 2024
K23HL148525
Principal Investigator: Rishi K. Wadhera
Long-Term Safety Outcomes Associated with Endovascular Aortic Repair for Treatment of Abdominal Aortic Aneurysm 2022 - 2023
Socioeconomic and Racial Disparities in the Dissemination of Novel Technologies to Address Valvular Heart Disease 2020 - 2022
Co-Investigator
Principal Investigator: Robert Yeh
Association of the ACA's Medicaid Expansion with Care and Outcomes for Heart Failure 2017 - 2018
American Heart Association Get with the Guidelines Young Investigator Grant
Principal Investigator: Rishi K. Wadhera
Mentorships
Prolonged Mechanical Ventilation: Patterns of Post-Acute Care and Patient Outcomes
NHLBI, NIH; K23
PI: Anica Law
Site Mentor: Rishi K. Wadhera