“Why would you not listen? It is like being given the winning lottery numbers and deciding not to take them”: semi-structured interviews with post-acute myocardial infarction patients and their significant others exploring factors that influence participation in cardiac rehabilitation and long-term exercise training

Regional Cardiocerebrovascular Centers (RCCs)—a Korean government initiative—seek to reduce medical gaps across regions, and their cardiac rehabilitation (CR) programs are expected to model post-acute care for the Korean CR program. Accordingly, this study aimed to evaluate the current status of CR programs in the RCCs. We distributed surveys on the CR condition, activity, and barriers to 12 RCCs in different provinces. The results revealed significant gaps in the annual number of acute myocardial infarction admissions, and CR candidates, capacity, and density across the 12 RCCs. The CR capacity (50–500) and density (0.42–7.36) indicated particularly large gaps. Twelve RCCs had the necessary facilities, equipment and personnel for CR assessments and management, with high CR referral (97%) and patient education (78%) rates. However, the inpatient CR exercise training (56%) participation rate was inadequate, with much lower enrollment (47%) and adherence (17%) rates to the outpatient CR program and large differences across centers. Therefore, this study’s results will provide the evidence required to establish special national health strategies to overcome the CR barriers of patient, doctor/hospital, and policy factors for activating Korean CR programs.

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Improvement of exercise capacity after acute myocardial infarction in patients included in a cardiac rehabilitation program with or without an specific exercise training protocol

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/00149831-200605001-00300 ◽

2006 ◽

Vol 13 (Supplement 1) ◽

pp. S75

Author(s):

N??ria Casanovas ◽

Paula Cabero ◽

Esther Marco ◽

Alejandro Robles ◽

Montserrat Batll?? ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Exercise Training ◽

Cardiac Rehabilitation ◽

Exercise Capacity ◽

Rehabilitation Program ◽

Cardiac Rehabilitation Program ◽

Specific Exercise ◽

Training Protocol

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P6211Efficacy of comprehensive Managed Care after Acute Myocardial Infarction (MC-AMI) in a long-term follow-up - preliminary experience of a single high-volume center

European Heart Journal ◽

10.1093/eurheartj/ehz746.0816 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Wita ◽

K Wilkosz ◽

M Wita ◽

A Kulach ◽

M Wybraniec ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Managed Care ◽

Cardiac Rehabilitation ◽

Cox Regression ◽

Icd Implantation ◽

Cox Regression Analysis ◽

Long Term Prognosis

Abstract Introduction Despite substantial progress in the medical and interventional treatment of acute myocardial infarction (AMI), a long-term prognosis in MI survivors remains unsatisfactory. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Purpose To assess the effect of MC-AMI on major adverse cardiovascular and cerebrovascular events (MACCE) in 12 months follow-up. Methods In this single-center, retrospective observational study we enrolled 1211 patients, out of which 719 consented for participation in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI on clinical endpoints. Results Primarily, MC-AMI has been proved to reduce MACCE rate by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%) higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p<0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p<0.05) and ICD implantation (2.8% vs. 0.6%, p<0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACCE at 12 months (HR=0.500, 95%Cl 0.349–0.718, p<0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint. 12-month FU - freedom from MACCE Conclusions MC-AMI is the first program of a comprehensive in-hospital and post-discharge care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE rate by 40% in 12 months. Participation in MC-AMI is inversely related to mortality rate, recurrent MI and heart failure related hospitalization during 12 months.

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