A nationwide survey on participation in cardiac rehabilitation among patients with coronary heart disease using health claims data in Japan

Genta Kato,Yuka Nakatani,Takeo Nakayama,Neiko Ozasa,Yukiko Mori,Hiroaki Ueshima,Tomohiro Kuroda,Shosuke Ohtera

doi:10.1038/s41598-021-99516-1

Abstract

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.

Highlights

Coronary heart disease (CHD) is the top cause of death globally, accounting for approximately 10 million deaths in 20161
In a logistic regression model, coronary artery bypass grafting (CABG) was associated with higher cardiac rehabilitation (CR) participation compared to percutaneous coronary intervention (PCI), younger age was associated with lower CR participation compared to age ≥ 75 years, and participants in Kyushu and Chugoku regions were more likely to participate in CR
The present study revealed a higher rate of CR participation among patients who underwent PCI or CABG than that reported in a previous study (24%) focused on a younger Japanese population aged ≤ 65 years[25]

Summary

Introduction

Coronary heart disease (CHD) is the top cause of death globally, accounting for approximately 10 million deaths in 20161. Exercisebased cardiac rehabilitation (CR) for patients with CHD reduces risks of cardiac mortality and hospital admission, and there is mounting evidence that exercise-based CR and patient education are beneficial for improving health-related quality of life[8,9,10]. Clinical practice guidelines internationally recommend comprehensive CR that includes exercise intervention, control of coronary risk factors, physical activity, and patient education by multidisciplinary professionals, as well as quality measurements, for secondary prevention of cardiovascular diseases[7,11,12,13,14,15]. In Japan, some studies suggested that CR is underutilized, and that ST-segment-elevation myocardial infarction and coronary artery bypass grafting (CABG) are factors that facilitate patient participation in C R24–26

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Results

Conclusion