Compliance and efficacy of cardiac rehabilitation and risk factor modification in the medically indigent

To compare the compliance and efficacy of cardiac rehabilitation in medically indigent patients with more affluent patients, we evaluated the first 65 patients referred to a new cardiac rehabilitation program of whom 36 were medically indigent (i.e., dependent on Medicaid for health care reimbursement) and 29 were funded by private medical insurance. Attendance during 12 weeks of monitored, supervised, phase II cardiac rehabilitation was examined retrospectively. In addition, training history, cardiovascular response to submaximal exercise, dietary fat intake, and smoking incidence were studied at baseline and repeated prospectively between 6 months and 1 year (8.2 +/- 1.1 months) after program completion. Both the indigent and private patients attended >90% of scheduled sessions and achieved a significant improvement in submaximal 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 fat. The indigent patients smoked more before the program but were equally successful at quitting cigarette smoking as the private patients. We conclude that in the appropriate setting, indigent patients can successfully complete and maintain excellent compliance with a program of coronary risk factor modification including exercise training, dietary modification, and cessation of cigarette smoking, to a degree equivalent to more affluent and educated patients. Compliance may be enhanced by employing a small program emphasizing extensive personal contact with rehabilitation staff.