What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Myocardial Infarction (n=64982). Intervention: Cardiac rehabilitation vs. No cardiac rehabilitation. Primary outcome: Cardiac rehabilitation participation rate.

January 1, 2020Open Access

Underutilization of Hospital-based Cardiac Rehabilitation after Acute Myocardial Infarction in Korea

SKSun-Hyung KimSeoul National University Bundang Hospital JRJun-Soo RoAjou University YKYoon KimBaylor College of Medicine

Key Result

Nationally, only 1.5% of acute myocardial infarction patients participated in hospital-based cardiac rehabilitation within 6 months of discharge.

Study Design

Type

Cohort (n=64,982)

Multicenter

Yes

Structured PICO

What is the national utilization rate and what are the influencing factors for hospital-based cardiac rehabilitation after acute myocardial infarction in Korea?

Population

64,982 patients aged 40 to 80 years hospitalized with acute myocardial infarction in South Korea, evaluated for cardiac rehabilitation participation within 6 months post-discharge.

Exposure

Hospital-based cardiac rehabilitation (CR) treatment or evaluation performed during an outpatient follow-up period within 6 months after discharge.

Outcome

Participation rate and density of cardiac rehabilitation use nationally and by administrative division.

Hospital-based cardiac rehabilitation after acute myocardial infarction is severely underutilized in Korea, with only a 1.5% participation rate despite national health insurance coverage.

Limitations

Diagnosis of AMI was operationally defined using medical claim records, risking false inclusion or exclusion.
National CR density calculation relied on median capacity estimates from a previous global survey, potentially underestimating true density.
Distance from CR facility to patient's home was not considered.
Potential mismatch between procedure, benefits, and claim records during the insurance transition period.
Unmeasured confounders such as physician referral patterns, driving ability, and education level.
Study confined to AMI, excluding other cardiovascular indications for cardiac rehabilitation.

Abstract

BACKGROUND: Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) is recommended as a mandatory intervention in several national clinical practice guidelines published in America, Europe, and Korea to reduce recurrence and mortality. However, underutilization of CR is an established worldwide issue. In Korea, the promotion of CR is expected due to coverage by National Health Insurance. Nevertheless, the national status of CR use has not been reported. This retrospective cohort study aimed to investigate the current status of CR use in patients with AMI using nationwide data from the National Health Insurance Service of Korea. METHODS: Patients with AMI admitted with the diagnosis of 'I21' code (from International Classification of Diseases, 10th revision, Clinical Modification) from July 1st, 2017 to June 30th, 2018 were included. CR use was defined as CR treatment or evaluation being performed during an outpatient follow-up period within 6 months after discharge. Participation rate and density were calculated nationally and by administrative division. Logistic regression analysis was performed to identify the influencing factors of CR participation. RESULTS: Nationally, 1.5% of AMI patients (960/64,982) underwent CR during outpatient treatment after discharge. CR density was approximately 10. Logistic regression analysis revealed that influencing factors included old age, female sex, rural residence, and low Charlson comorbidity index. CONCLUSION: Hospital-based CR after AMI is underutilized despite its coverage by the National Health Insurance. More CR facilities have to be installed according to the needs of CR in various regions.

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