Kim Chul, Sung Jidong, Lee Jong Hwa, Kim Won-Seok, Lee Goo Joo, Jee Sungju, Jung Il-Young, Rah Ueon Woo, Kim Byung Ok, Choi Kyoung Hyo, Kwon Bum Sun, Yoo Seung Don, Bang Heui Je, Shin Hyung-Ik, Kim Yong Wook, Jung Heeyoune, Kim Eung Ju, Lee Jung Hwan, Jung In Hyun, Jung Jae-Seung, Lee Jong-Young, Han Jae-Young, Han Eun Young, Won Yu Hui, Han Woosik, Baek Sora, Joa Kyung-Lim, Lee Sook Joung, Kim Ae Ryoung, Lee So Young, Kim Jihee, Choi Hee Eun, Lee Byeong-Ju, Kim Soon
Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Korea.
Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine-Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea.
Korean J Thorac Cardiovasc Surg. 2019 Aug;52(4):248-285. doi: 10.5090/kjtcs.2019.52.4.248. Epub 2019 Aug 5.
Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea.
This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified.
CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR.
Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
尽管心脏康复（CR）临床实践指南在全球范围内是一种有效且广泛应用的治疗方法，但在韩国尚未被广泛接受。鉴于心血管疾病是韩国第二大死因，迫切需要制定CR项目。2008年，韩国政府在11所大学医院实施了CR项目，作为其区域心脑血管中心项目的一部分，2019年还将增加3家医疗机构。此外，由于在全国范围内推广CR以及引入CR保险福利，全国已有40家医疗机构开始实施CR项目，同时越来越多的医疗机构也在准备提供CR服务。本研究的目的是制定基于证据的临床实践指南，以支持韩国CR的实施。
本研究基于对世界其他地区临床实践指南的分析、广泛的文献检索、对多项随机对照试验进行系统分析，以及由33位作者组成的临床实践指南管理、制定和评估委员会，这些作者主要来自21所大学医院和2所综合医院的康复专家、心脏病专家和胸外科医生。12名顾问，主要是康复、运动医学和预防医学专家、临床实践指南专家、护士、物理治疗师、临床营养师以及图书馆和信息专家参与了这些临床实践指南的研发。在制定指南草案后，与相关学术团体和利益相关者的工作人员举行了3轮公开听证会，之后对指南进行了进一步审查和修改。
相对于一般治疗，CR能更具成本效益地利用医疗资源，且CR的运动部分可降低心血管疾病死亡率和再入院率，无论冠心病类型以及CR的类型和环境如何。
应综合考虑包括心功能和生活方式差异等多种因素来制定个体化的CR项目，这样做将提高对CR项目的参与度和依从性，最终实现该项目的最终目标，即降低心肌梗死复发率和死亡率。
