AIMS: The participation rate for cardiac rehabilitation (CR) remains low in Asia including Korea. The aim of this study was to investigate effects of insurance benefits of CR on 1-year mortality, participation rate and cost-effectiveness in patients with acute coronary syndrome (ACS) in Korea.
METHODS: The Health Insurance Review and Assessment Service (HIRA) claim database, which comprises nationwide medical insurance data of Koreans from 2017–2018, was assessed to determine the current status of ACS. Data from a total of 97,580 patients were collected.
RESULTS: During the survey, a total of 97,580 patients were diagnosed with acute myocardial infarction or unstable angina, of which 8,108 were participated in CR and 89,472 were nonparticipating patients. Among the participants in the CR program, 37.54% of the patients received only a CR evaluation or education. 44.18% of only one CR trial, 14.92% of 2-10 trials, and 4.64% of above 10 trials were confirmed, with the largest number of patients being treated only once. The largest number of CR participants at third hospitals was 80.99%, followed by Seoul with 48.84% by region, followed by Gyeonggi Province with 13.26%, Busan with 6.81% and Daegu with 6.36%. After adjusting for potential confounders, 40 of 4187 patients in the CR group and 621 of 49,210 patients in the non-CR group had major adverse cardiac events (MACE) within a year. MI recurrence, revascularization, readmission due to cardiovascular disease, readmission due to other reasons, MACE were not significantly different between CR and non-CR groups.
CONCLUSION: In this study, 1-year mortality did not decrease in patients with ACS who had participated in CR compared to those who did not. Long-term study more than 3 years is needed to clarify the effect of CR on the clinical outcomes of ACS including mortality. Despite the insurance benefit of CR, the number of CR participants and the frequency of participation were very low. Therefore, more active national intervention and support would be needed to promote CR by awareness and participation in CR in a country like Korea where CR has not yet been actively implemented. |
