Real-World Impact of Cardiac Rehabilitation Education and Therapy on Clinical Outcomes after Acute Myocardial Infarction: A Korean Cohort Analysis

Purpose: Cardiac rehabilitation (CR) is central to tertiary prevention after acute myocardial infarction (AMI), but the prognostic impact of different education and therapy patterns in Asian real world practice is uncertain. Materials and Methods:Using Korean National Health Insurance Service claims (2018-2022), we identified patients aged ≥40 years hospitalized for AMI who underwent thrombolysis, percutaneous coronary intervention, or coronary artery bypass grafting.CR exposure was classified into six groups by structured education and the number of supervised therapy sessions, and outcomes over 2 years included all cause readmission, readmission and emergency room (ER) visits for MI or unstable angina (UA), all cause mortality, repeat revascularization, and stroke.Multivariable Cox models estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs).Results: Among 92968 patients, 85.5% received no CR, 3.2% had education only, and 11.3% received any therapy.Education only participants had the lowest crude rates of mortality, cardiovascular readmission, and repeat revascularization.All CR exposed groups showed lower all cause mortality, with the greatest benefit in education plus ≥4 therapy sessions (HR 0.257, 95% CI 0.123-0.539)and ≥4 therapy sessions without education (HR 0.291, 95% CI 0.203-0.417).Education focused CR was additionally associated with lower cardiovascular readmission and repeat revascularization, whereas readmission and ER visits varied across therapy intensive groups.Conclusion: In this nationwide Korean AMI cohort, CR participation, especially with education, was associated with substantial mortality reduction, suggesting structured education as a pragmatic cornerstone of tertiary prevention, with supervised therapy providing incremental benefit when available.