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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Trends in Cardiac Rehabilitation Participation in Patients With Acute Myocardial Infarction: A 5-Year Nationwide
Hyeongsu Kim1, Ra Yu Yun2, Chul Kim3
1Department of Preventive Medicine, Konkuk University College of Medicine, Seoul, Korea.
Insights
Cardiac rehabilitation (CR) participation for acute myocardial infarction (AMI) patients in Korea is increasing, but sustained treatment remains low. Factors like socioeconomic status and hospital type influence CR access, necessitating policy improvements for better utilization.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiac rehabilitation (CR) is vital for secondary prevention after acute myocardial infarction (AMI).
- Despite National Health Insurance coverage in Korea since 2017, CR participation rates are suboptimal.
- Understanding trends and barriers to CR is crucial for improving patient outcomes.
Purpose of the Study:
- To assess trends in CR participation among AMI patients in Korea from 2018-2022.
- To identify factors associated with non-participation in CR treatment.
- To inform policy for enhancing CR utilization.
Main Methods:
- Retrospective analysis of National Health Insurance Service claims data (2018-2022).
- Inclusion of patients aged ≥40 hospitalized for AMI receiving acute interventions (thrombolysis, PCI, CABG).
- Multivariable logistic regression to identify non-participation factors, focusing on patients at CR-providing institutions.
Main Results:
- Overall CR education, assessment, and treatment participation increased from 2018-2022.
- Sustained outpatient CR treatment completion (≥11 sessions) remained low (5.7% in 2022).
- Lower treatment participation linked to no prior education/assessment, lower socioeconomic status, PCI vs. CABG, and non-tertiary hospitals; regional disparities and infrastructure gaps also noted.
Conclusions:
- CR participation for AMI patients in Korea shows gradual increase, but treatment continuity is suboptimal.
- Policy interventions should focus on reducing patient burden and provider barriers.
- Enhancing equitable access via financial support and infrastructure expansion is recommended.
Background:
Cardiac rehabilitation (CR) is a critical secondary prevention strategy for patients with acute myocardial infarction (AMI). Although CR has been covered by the National Health Insurance in Korea since 2017, real-world participation remains suboptimal. We assessed trends in CR participation over the past 5 years and identified factors associated with non-participation in treatment.
Methods:
This retrospective observational study analyzed data from the National Health Insurance Service claims database between 2018 and 2022. Patients aged ≥ 40 years who were hospitalized for AMI and received acute-phase interventions, such as thrombolysis, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG), were included. CR participation was defined as having at least one claim for education, assessment, or treatment services. Multivariable logistic regression was conducted to identify factors associated with non-participation in CR treatment, focusing on patients who received care at CR-providing institutions, to minimize confounding related to institutional availability.
Results:
In total, 109,436 patients were included. Overall participation rates in CR education, assessment, and treatment increased from 2018 to 2022. However, sustained participation in outpatient treatment remained low, with only 5.7% of patients in 2022 completing ≥ 11 treatment sessions. Factors associated with lower treatment participation included the absence of prior education and assessment, lower socioeconomic status, undergoing PCI rather than CABG, and receiving care at non-tertiary hospitals. Regional disparities and inadequate institutional infrastructure further contributed to reduced access to CR services.
Conclusion:
Although CR participation among patients with AMI in Korea has gradually increased, treatment continuity remains suboptimal. To enhance CR utilization, policy efforts should prioritize reducing patient burden, addressing provider-level barriers, and promoting equitable access through financial support mechanisms and infrastructure expansion.
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