Current status of cardiac rehabilitation among representative hospitals treating acute myocardial infarction in South Korea

Abstract

Cardiac rehabilitation services are mostly underutilized despite the documentation of substantial morbidity and mortality benefits of cardiac rehabilitation post-acute myocardial infarction. To assess the implementation rate and barriers to cardiac rehabilitation in hospitals dealing with acute myocardial infarction in South Korea, between May and July 2016, questionnaires were emailed to cardiology directors of 93 hospitals in South Korea; all hospitals were certified institutes for coronary interventions. The questionnaires included 16 questions on the hospital type, cardiology practice, and implementation of cardiac rehabilitation. The obtained data were categorized into two groups based on the type of the hospital (secondary or tertiary) and statistically analysed. Of the 72 hospitals that responded (response rate of 77%), 39 (54%) were tertiary medical centers and 33 (46%) were secondary medical centers. All hospitals treated acute myocardial infarction patients and performed emergency percutaneous coronary intervention; 79% (57/72) of the hospitals performed coronary artery bypass grafting. However, the rate of implementation of cardiac rehabilitation was low overall (28%, 20/72 hospitals) and even lower in secondary medical centers (12%, 4/33 hospitals) than in tertiary centers (41%, 16/39 hospitals, p = 0.002). The major barriers to cardiac rehabilitation included the lack of staff (59%) and lack of space (33%). In contrast to the wide availability of acute-phase invasive treatment for AMI, the overall implementation of cardiac rehabilitation is extremely poor in South Korea. Considering the established benefits of cardiac rehabilitation in patients with acute myocardial infarction, more administrative support, such as increasing the fee for cardiac rehabilitation services by an appropriate level of health insurance coverage should be warranted.

Barriers to Participation in Cardiac Rehabilitation Among Patients with Coronary Heart Disease After Reperfusion Therapy: A Scoping Review

“… 12.3%, Directly at the hospital, Phase II N/I 9/11 (Harrison & Wardle, 2005) 40 Cross-sectional study United Kingdom 67.34± 10.95 313 Female (31.4%) Male (68.6%%) Age (OR 1.90, 95% CI 1.01–3.56) ( p =0.020) Gender (OR 0.48, 95% CI 0.22–1.03) ( p =0.020). Major reported barrier: Access to CR service, including public transport, parking and the time and location of classes, geographical access, and living in an urban or rural electoral ward 75.4%, Directly at the hospital, Phase II and III N/I 6/8 (Grace et al, 2009) 27 Prospective Study Canada 65.9±11.2 1.273 Female (28.5%) Male (71.5%) Older age ( p <0.001)* Already exercising at home ( p <0.001)* Confidence in the ability to self-Manage their condition ( p =0.003)* Perception of exercise ( p <0.001)* Knowledge about CR ( p <0.001)* Lack of physician encouragement ( p <0.001)* Comorbidities ( p <0.001)* The perception that CR would not improve their health ( p <0.001)* 43%, Directly at the hospital, N/I Survey 8/11 (Park et al, 2021) 9 Cross-sectional study Korea N/I 72 hospitals Tertiary medical centre (54%) Secondary medical centre (46%) Lack of staff (59%) and space (33%) 77%, Directly at the hospital, N/I N/I 6/8 (Kim et al, 2022) 19 Cross-sectional study Korea N/I 132 hospitals Hospitals with CRP (35.6%) Hospitals without CRP (64.4%) Patients’ transportation ( p ...…”

“…Based on the categorization of participation rates in CR, it shows that most of the studies analyzed show a low participation rate (n=12), 10 , 13 , 23 , 26–28 , 34 , 35 , 38 , 39 , 41 , 43 moderate participation rate (n=7), 7 , 11 , 16 , 33 , 36 , 37 , 42 and a high participation rate CR (n=4). 9 , 19 , 22 , 40 …”

“…Furthermore, most CR program types undertaken by participants from the studies were carried out in hospitals 7 , 9–11 , 13 , 16 , 19 , 23 , 26–28 , 33 , 37–43 and only the study by Cao et al, 2021 which report home and exercise-based CR with most of the participants had a moderate participation rate (64.66%). 36 Furthermore, two studies did not mention the type of CR program.…”

“… 19 , 34 Meanwhile, another barrier that also influences the low participation of CR is the need for more supporting facilities (equipment, space, staffing) in hospitals without CR compared to hospitals with CR. 9 , 19 This is an essential obstacle in supporting patient participation in attending CR in small hospitals in their area, especially patients who live in rural areas. 16 , 40 …”

Fact Sheet on Cardiac Rehabilitation for Cardiovascular Disease in South Korea

“…Although contemporary clinical guidelines strongly recommend referring CVD patients to CR, access to CR programs in Korea remains limited. About 40% of patients participate in CR worldwide, but in Korea, the participation rate is lower [ 11 ].…”