Abstract 17829: Improving Access to Cardiac Rehabilitation for Minorities and Vulnerable Patients With a Multidisciplinary Program in a Large Metropolitan Public Hospital Network

Abstract

Introduction: Cardiac rehabilitation (CR) improves outcomes after myocardial infarction, cardiac surgery or in chronic heart failure with reduced ejection fraction. However, access to CR is often limited to insured patients or those who can pay out-of-pocket, leaving uninsured or undocumented patients without access to these benefits. Our aim is to describe the implementation and outcomes of a multidisciplinary comprehensive CR program in the largest public health system in the country, as a strategy to mitigate healthcare disparities and improve access to care for minorities. Methods: Our CR program started in March 2021 as a virtual program and opened for in-person care in November 2022. We collected clinical, demographic, socioeconomic, and immigration data as well as data on clinical outcomes such as hospital readmission, mortality, and program completion rates. Results: A total of 202 patients were included (35.6% women, mean age 62), with 83.7% of patients in virtual CR and 16.3 % in in-person CR. The most common ethnic group was Black (41.6%) followed by Hispanic (38.6%). A total of 23.8% were uninsured, 21.3% were undocumented and 52.5% lived below the poverty level reported for New York City. The highest level of education was < 8th grade in 16.8%, high school in 22.8%, at least 2 years of college in 5.5%, > 4 years of college in 7.9% and unknown in 47%. The hospital readmission rate at 6 months was 12.4% and mortality was 1.5%. There were no significant differences in survival or readmission by ethnic group. Of patients completing at least one visit, 72% were active or graduated from virtual CR and 90% were active or graduated for in-person CR (Figure). Conclusions: Our multidisciplinary CR program demonstrates feasibility in providing care to underserved and vulnerable populations, showing excellent results and providing a strategy to decrease healthcare disparities in access to an intervention which improves outcomes across a broad spectrum of cardiac disease.