Key result
Missing post-AMI cardiac rehabilitation education and assessment is linked to ~17-fold higher outpatient non-participation.
Why the study?
Although cardiac rehabilitation has been covered by National Health Insurance in Korea since 2017, real-world participation among patients with acute myocardial infarction remains suboptimal.
Observational (n=109,436)
Yes
Odds Ratio: 16.85 (95% CI 12.06–17.67)
p-value: p=<0.001
Despite national health insurance coverage, cardiac rehabilitation participation after AMI in Korea remains suboptimal, highlighting the need to address patient and provider-level barriers to improve secondary prevention.
CR participation after AMI remains low in Korea despite coverage; leaves open whether targeting education and CABG preference boosts uptake.
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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Kim et al. (2025) conducted an observational in Acute Myocardial Infarction (n=109,436). Absence of prior CR education and assessment vs. Receipt of both CR education and assessment was evaluated on Non-participation in cardiac rehabilitation treatment (OR 16.85, 95% CI 12.06-17.67, p=<0.001). Absence of prior cardiac rehabilitation education and assessment was strongly associated with non-participation in outpatient treatment (OR 16.85) among patients with acute myocardial infarction.
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