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European Journal of Physical and Rehabilitation Medicine 2020 May 08

DOI: 10.23736/S1973-9087.20.06081-5


lingua: Inglese

Cardiac rehabilitation and 5-year mortality after acute myocardial infarction: report from 11 tertiary hospitals in Korea (ETHIK study)

Chul KIM 1, Insun CHOI 2, Songhee CHO 2, Jae-Young HAN 3 , Ae-Ryoung KIM 4, Won-Seok KIM 5, Sungju JEE 6, Jong H. LEE 7, Min C. JOO 8, Heui J. BANG 9, Kyung-Lim JOA 10, Eun Y. HAN 11, Sora BAEK 12, Jung-Im SHIM 2, Jin A. CHOI 2

1 InJe University Sanggye Paik Hospital, Seoul, Republic of Korea; 2 National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; 3 Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea; 4 KyungPook National University Hospital, Daegu, Republic of Korea; 5 Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 6 Chungnam National University Hospital, Daejeon, Republic of Korea; 7 Dong-A University College of Medicine and Dong-A Medical Center, Busan, Republic of Korea; 8 Wonkwang University Hospital, Jeonbuk-Do, Republic of Korea; 9 Chungbuk National University Hospital, Chungbuk-Do, Republic of Korea; 10 InHa University Hospital, Incheon, Republic of Korea; 11 Jeju University Hospital, Jeju-Do, Republic of Korea; 12 Kangwon National University School of Medicine, Kangwon National University Hospital, Gangwon-Do, Republic of Korea

BACKGROUND: The participation rate for cardiac rehabilitation (CR) remains low in some Europe and Asia including Korea.
AIM: To investigate effects of CR on prognosis improvements in terms of recurrence, readmission, revascularization, and mortality rates in patients with acute myocardial infarction (AMI) in Korea.
DESIGN: A retrospective cohort study.
SETTING: Eleven Tertiary Hospitals In Korea (ETHIK study).
POPULATION: Data from a total of 7,299 patients between January 2012 and December 2015 were collected, of which data from 7,136 patients were linked to insurance claims data. In the final analysis, 6,743 patients were included.
METHODS: Patients who participated in the CR program while receiving outpatient treatment were classified into CR group. Those who did not participate in CR programs were classified into the non-CR group.
RESULTS: Kaplan-Meier survival analyses showed five-year survival rate of 96.9% in the CR group and 93.3% in the non-CR group. The hazard ratio (HR) for total 5-year mortality in the CR group was approximately 0.41 (95% CI: 0.27-0.63) times that of the non-CR group, indicating a reduction in the risk of mortality by approximately 59% in propensity score weighted cohort of 1,878 patients. The HR for major adverse cardiac events (MACE) with respect to 5-year mortality, MI recurrence, revascularization, and readmission due to cardiovascular disease in CR group was 0.96 times that of non-CR group (95% CI 0.83-1.12), without significant difference between the two groups.
CONCLUSIONS: In this study, 5-year mortality decreased by 59% in patients with AMI who had participated in CR compared to those who did not.
CLINICAL REHABILITATION IMPACT: This finding should be very helpful in emphasizing the need for CR in a country like Korea where CR has not yet been actively implemented.

KEY WORDS: Cardiac rehabilitation; Mortality; Acute myocardial infarction; Prognosis; Cohort study

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