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

Myung Soo Park,Eung Ju Kim,Jae Hyuk Choi,Sunki Lee,Kyu Hyung Ryu,Doyoung Kim,Taehoon Ahn,Mi-Hyang Jung,Seongwoo Han,Salil Deo

doi:10.1371/journal.pone.0261072

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.

Highlights

Coronary heart disease (CHD) is a major cause of death and medical expenses in many developed countries [1, 2]
This is the first nationwide investigation of Cardiac rehabilitation (CR) implementation among hospitals certified for coronary interventions in South Korea
Most hospitals without CR programs cited the lack of manpower and space as the biggest obstacles to undertaking CR programs

Summary

Introduction

Coronary heart disease (CHD) is a major cause of death and medical expenses in many developed countries [1, 2]. Cardiac rehabilitation after AMI in South Korea patients are living longer with symptoms because of the major diagnostic and therapeutic developments for CHD in the last few decades [3]. Due to its increasing incidence, CHD has become a rising health problem and is the second largest cause of death from a single organ disease in South Korea [4]. Due to the widespread use of effective reperfusion therapy and optimal medical treatment, the mortality rate of CHD in South Korea has recently been on the decline, and the survivors need stronger strategies of recovery and secondary prevention [5]

Methods

Results

Conclusion