Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan.
Sci Rep. 2021 Oct 11;11(1):20096. doi: 10.1038/s41598-021-99516-1.
Poor implementation and variable quality of cardiac rehabilitation (CR) for coronary heart disease (CHD) have been a global concern. This nationwide study aimed to clarify the implementation of and participation in CR among CHD patients and associated factors in Japan. We conducted a retrospective cohort study using data extracted from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in 2017-2018 were included. Aspects of CR were assessed in terms of (1) participation in exercise-based CR, (2) pharmacological education, and (3) nutritional education. Of 87,829 eligible patients, 32% had participated in exercise-based CR, with a mean program length of 40 ± 71 days. CABG was associated with higher CR participation compared to PCI (OR 10.2, 95% CI 9.6-10.8). Patients living in the Kyushu region were more likely to participate in CR (OR 2.59, 95% CI 2.39-2.81). Among patients who participated in CR, 92% received pharmacological education, whereas only 67% received nutritional education. In Japan, the implementation of CR for CHD is insufficient and involved varying personal, therapeutic, and geographical factors. CR implementation needs to be promoted in the future.
在全球范围内，冠心病（CHD）心脏康复（CR）的实施情况较差且质量参差不齐。本项全国性研究旨在阐明日本 CHD 患者 CR 的实施情况和参与情况及其相关因素。我们使用从日本国民健康保险索赔和特定健康检查国家数据库中提取的数据进行了回顾性队列研究。纳入 2017-2018 年接受经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）的患者。CR 的评估方面包括：（1）参加基于运动的 CR，（2）药物教育，以及（3）营养教育。在 87829 名合格患者中，有 32%参加了基于运动的 CR，平均疗程为 40±71 天。与 PCI 相比，CABG 与更高的 CR 参与率相关（OR 10.2，95%CI 9.6-10.8）。居住在九州地区的患者更有可能参加 CR（OR 2.59，95%CI 2.39-2.81）。在参加 CR 的患者中，92%接受了药物教育，而只有 67%接受了营养教育。在日本，CHD 的 CR 实施情况不足，涉及个人、治疗和地理等多种因素。未来需要促进 CR 的实施。
