Abstract 13289: Medicaid Patients in Cardiac Rehabilitation: Underrepresented, High Risk, High Need

Abstract

Purpose: Patients with lower-socioeconomic status (SES) have higher rates of cardiovascular (CV) events and therefore, have the most to gain from cardiac rehabilitation (CR). Unfortunately, those with lower-SES are much less likely to engage in CR which has made characterization of this population quite difficult. Our CR program specifically increased recruitment of lower-SES patients, allowing for careful comparison of medical, psychosocial, and behavioral risk factors between lower and higher-SES patients eligible for secondary prevention. Methods: Demographic and clinical characteristics were prospectively gathered on consecutive individuals entering Phase 2 CR from 1/2014-12/2022. Patients were classified as lower-SES if they had Medicaid insurance. Statistical methods included chi-square and non-paired t-tests. A p value of <0.01 was used to determine significance. Results: The entire cohort consisted of 3131 individuals. Compared to higher-SES patients, lower-SES individuals (n=405, 13%) were a decade younger, almost 6 times more likely to be current smokers, nearly 3 times more likely to have elevated depressive symptoms, and had significantly higher body mass index, waist circumference, and hemoglobin A1c, with more abnormal lipid profiles (all p<0.001). Despite being a decade younger, lower-SES patients had lower measures of peak VO 2 and self-reported lower levels of physical function (both p<0.001). Conclusion: Lower-SES patients have a remarkably prominent high-risk CV profile resulting in a substantially higher risk for a recurrent coronary event than higher-SES patients. Accordingly, strong efforts must be placed to engage this high-risk population in CR. It is imperative for CR programs to ensure that they are appropriately equipped to intervene on risk factors such as low fitness, depression, and smoking.