COMPLIANCE AND EFFICACY OF CARDIAC REHABILITATION AND RISK FACTOR MODIFICATION IN THE MEDICALLY INDIGENT

To compare the compliance and efficacy of cardiac rehabilitation in me dically indigent patients with more affluent patients, we evaluated th e first 65 patients referred to a new cardiac rehabilitation program o f whom 36 were medically indigent (i.e., dependent on Medicaid for hea lth care reimbursement) and 29 were funded by private medical insuranc e. Attendance during 12 weeks of monitored, supervised, phase II cardi ac rehabilitation was examined retrospectively. In addition, training history, cardiovascular response to submaximal exercise, dietary fat i ntake, and smoking incidence were studied at baseline and repeated pro spectively between 6 months and 1 year (8.2 +/- 1.1 months) after prog ram completion. Both the indigent and private patients attended >90% o f scheduled sessions and achieved a significant improvement in submaxi mal work capacity which was well maintained at the time of follow-up. Also, both groups continued to eat a diet low in saturated and total f at. The indigent patients smoked more before the program but were equa lly successful at quitting cigarette smoking as the private patients. We conclude that in the appropriate setting, indigent patients can suc cessfully complete and maintain excellent compliance with a program of coronary risk factor modification including exercise training, dietar y modification, and cessation of cigarette smoking, to a degree equiva lent to more affluent and educated patients. Compliance may be enhance d by employing a small program emphasising extensive personal contact with rehabilitation staff. (C) 1997 by Excerpta Medica, Inc.