Department of Rehabilitation Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2023 Apr 17;38(15):e119. doi: 10.3346/jkms.2023.38.e119.
To investigate the actual rate and quality of cardiac rehabilitation (CR) participation in South Korea and its short-term impact on clinical outcomes after acute coronary syndrome (ACS).
Data, including confirmed ACS diagnosis, socio-demographics, comorbidities, clinical outcomes, and CR claim codes, were collected from the Korean National Health Insurance Service claims database and compared between the CR and non-CR groups.
Overall, 102,544 patients were included in the study, of which only 5.8% attended CR. Regarding testing, 83.6% of CR patients performed the cardiopulmonary exercise test, but follow-up testing was infrequently performed; in addition, 53.1% of them participated in an electrocardiogram monitoring exercise, but over half participated in only one session. After 1:1 propensity score matching, post-ACS cardiovascular events were significantly lower in the CR group than in the non-CR group. The cumulative 3-year hazard ratio for all-cause death was 0.612 (95% confidence interval [CI], 0.495-0.756), recurrent ACS was 0.92 (95% CI, 0.853-0.993), CR readmission was 0.817 (95% CI, 0.768-0.868), and major adverse cardiovascular events (MACE) was 0.827 (95% CI, 0.781-0.874) in the CR group. CR was associated with a significant dose-response effect on MACE, with a reduction in incidence from 0.854 to 0.711.
The actual rate of CR participation in South Korea remains low, and participation quality was not outstanding despite National Health Insurance coverage. Nevertheless, the impact of CR on cardiovascular outcomes after ACS was significantly superior. Efforts to increase CR participation should be increased by establishing new CR facilities and strategies to resolve associated barriers.
本研究旨在调查韩国心脏康复（CR）的实际参与率和质量及其对急性冠状动脉综合征（ACS）后临床结局的短期影响。
本研究从韩国国家健康保险服务索赔数据库中收集了包括确诊 ACS 诊断、社会人口统计学、合并症、临床结局和 CR 索赔代码在内的数据，并将其与 CR 组和非 CR 组进行了比较。
在这项研究中，共有 102544 名患者，其中只有 5.8%的患者参加了 CR。在检查方面，83.6%的 CR 患者进行了心肺运动试验，但随访检查的开展频率较低；此外，53.1%的患者进行了心电图监测运动，但超过一半的患者只参加了一次。在进行 1:1 倾向评分匹配后，CR 组的 ACS 后心血管事件发生率明显低于非 CR 组。累积 3 年全因死亡风险比为 0.612（95%置信区间[CI]，0.495-0.756），复发性 ACS 为 0.92（95% CI，0.853-0.993），CR 再入院为 0.817（95% CI，0.768-0.868），主要不良心血管事件（MACE）为 0.827（95% CI，0.781-0.874）。CR 与 MACE 呈显著剂量反应关系，发生率从 0.854 降至 0.711。
尽管韩国的国家健康保险覆盖了 CR，但韩国的 CR 实际参与率仍然较低，参与质量也不高。然而，CR 对 ACS 后心血管结局的影响明显更好。应通过建立新的 CR 设施和解决相关障碍的策略，增加 CR 的参与率。
