Cardiac Rehabilitation and 5-year Mortality After Acute Myocardial Infarction. Report from 11 Tertiary Hospitals in Korea (ETHIK Study)

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 7299 patients between January 2012 and December 2015 were collected, of which data from 7136 patients were linked to insurance claims data. In the final analysis, 6743 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 1878 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.