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

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261072
Author(s):  
Myung Soo Park ◽  
Sunki Lee ◽  
Taehoon Ahn ◽  
Doyoung Kim ◽  
Mi-Hyang Jung ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
South Korea ◽  
Cardiac Rehabilitation ◽  
Administrative Support ◽  
Artery Bypass ◽  
Current Status ◽  
Rehabilitation Services ◽  
Invasive Treatment ◽  
Medical Centers

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.

scholarly journals Current Status of Cardiac Rehabilitation in the Regional Cardiocerebrovascular Centers in Korea

2021 ◽  
Vol 10 (21) ◽  
pp. 5079
Author(s):  
Chul Kim ◽  
Jidong Sung ◽  
Jae-Young Han ◽  
Sungju Jee ◽  
Jang Woo Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Patient Education ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Acute Care ◽  
Participation Rate ◽  
Current Status ◽  
Annual Number ◽  
Government Initiative

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.

Temporal Trends in Drug Abuse in Adults with Acute Myocardial Infarction Show Worse Outcomes

2017 ◽  
Vol 41 (S1) ◽  
pp. s247-s247
Author(s):  
Z. Mansuri ◽  
S. Patel ◽  
P. Patel ◽  
O. Jayeola ◽  
A. Das ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Drug Abuse ◽  
Hospital Admissions ◽  
Artery Bypass ◽  
Temporal Trends ◽  
International Classification Of Diseases ◽  
Specialty Care ◽  
Trend Test ◽  
Invasive Treatment

ObjectiveTo determine temporal trends, invasive treatment utilization and impact on outcomes of pre-infarction drug abuse (DA) on acute myocardial infarction (AMI) in adults.BackgroundDA is important risk factor for AMI. However, temporal trends in drug abuse on AMI hospitalization outcomes in adults are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AMI and DA as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used the CochraneArmitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.67% had DA. Proportion of hospitalizations with DA increased from 5.63% to 12.08% (P trend < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with DA (7.83% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with DA (aOR 0.811; 95% CI 0.693–0.735; P < 0.001) but discharge to specialty care was higher (aOR 1.076; 95% CI 1.025–1.128; P < 0.001). The median cost of hospitalization (40,834 vs. 37,253; P < 0.001) was higher in hospitalizations with DA.ConclusionsWe demonstrate an increasing proportion of adults admitted with AMI have DA over the decade. However, DA has paradoxical association with mortality in adults. DA is associated with lower CABG utilization and higher discharge to specialty care, with a higher mean cost of hospitalization. The reasons for the paradoxical association of DA with mortality and worse morbidity outcomes need to be explored in greater detail.Disclosure of interestThe authors have not supplied their declaration of competing interest.

P2518Failure of completion of post-myocardial infarction rehabilitation programme - Who and why? Single center experience with novel Coordinated Comprehensive Care program in Poland

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W Telec ◽  
P Kalmucki ◽  
H Krysztofiak ◽  
A Szyszka ◽  
A Baszko
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Laboratory Data ◽  
Care Program ◽  
Rehabilitation Programme ◽  
Comprehensive Care ◽  
Invasive Treatment ◽  
Laboratory Test Results ◽  
Number Of Patients

Abstract Background Rehabilitation after acute myocardial infarction is a well-proven strategy to improve outcomes and reduce complications rate. Poland recently introduced a novel, fully-reimbursed Coordinated Comprehensive Care (CCC) program after myocardial infarction, a significant portion of which comprises access to free-of-charge cardiac rehabilitation. Purpose The purpose of the study was to analyze all patients qualified for the Coordinated Comprehensive Care Program and evaluate reasons for not completing rehabilitation. We compared two groups of patients - those who completed the rehabilitation and those that did not - in terms of clinical, demographic and laboratory characteristics. Methods All patients (n=169) referred from the cardiology department for the CCC program were included in the study. They were divided into two groups, depending on single, strict criterium of completion or non-completion of the rehabilitation program. Demographic, clinical and laboratory data were collected and analyzed. Results The majority of the patients (n=100, 59.2%) did not undergo cardiac rehabilitation. 61 of them were not qualified for rehabilitation programme by the consortium of doctors: 33 of them due to the need for further invasive treatment, the remainder 28 were disqualified due to severe comorbidities. 32 patients did not commence the program despite referral and encouragement, mostly (n=25) due to personal reasons, 7 patients did not specify reasons for not participating in the rehabilitation. 7 patients were lost to follow-up. Patients who completed rehabilitation (n=69, 40.8%) were younger that those who did not (64.4±9.8 vs. 67.1±9.5 years, respectively; p=0.076), had significantly higher baseline LVEF (49.1±9.4 vs. 44.7±11.9%, p<0.03), and had lower serum creatinine level (0.99±0.28 vs. 1.15±0.59 mg/dl; p<0.03). There were more patients with LVEF<35% (n=23; 23%) in the no-rehabilitation, than in the other group (n=5; 7.25%; p<0.01). Rehabilitation completed (n=69) Rehabilitation NOT completed (n=100) p Gender – male 40 (35.4%) 73 (64.6%) <0.05 LVEF- % 49.12 (±9.43) 44.69 (±11.97) <0.03 No. of patients with EF <35% 5 (7.25%) 23 (23%) <0.01 Conclusion Although fully-reimbursed cardiac rehabilitation is provided for all patients following acute myocardial infarction, there is a significant number of patients who fail to complete the programme. This group comprises more male patients with worse clinical and laboratory test results, especially LVEF and renal function. Efforts should be made to address the problem and modify the programme accordingly.

scholarly journals Pericoronary fat inflammation and Major Adverse Cardiac Events (MACE) in prediabetic patients with acute myocardial infarction: effects of metformin

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Celestino Sardu ◽  
Nunzia D’Onofrio ◽  
Michele Torella ◽  
Michele Portoghese ◽  
Francesco Loreni ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Adipose Tissue ◽  
Artery Bypass ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Metformin Therapy ◽  
Adverse Cardiac Events ◽  
Factor Α

Abstract Background/objectives Pericoronary adipose tissue inflammation might lead to the development and destabilization of coronary plaques in prediabetic patients. Here, we evaluated inflammation and leptin to adiponectin ratio in pericoronary fat from patients subjected to coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI). Furthermore, we compared the 12-month prognosis of prediabetic patients compared to normoglycemic patients (NG). Finally, the effect of metformin therapy on pericoronary fat inflammation and 12-months prognosis in AMI-prediabetic patients was also evaluated. Methods An observational prospective study was conducted on patients with first AMI referred for CABG. Participants were divided in prediabetic and NG-patients. Prediabetic patients were divided in two groups; never-metformin-users and current-metformin-users receiving metformin therapy for almost 6 months before CABG. During the by-pass procedure on epicardial coronary portion, the pericoronary fat was removed from the surrounding stenosis area. The primary endpoints were the assessments of Major-Adverse-Cardiac-Events (MACE) at 12-month follow-up. Moreover, inflammatory tone was evaluated by measuring pericoronary fat levels of tumor necrosis factor-α (TNF-α), sirtuin 6 (SIRT6), and leptin to adiponectin ratio. Finally, inflammatory tone was correlated to the MACE during the 12-months follow-up. Results The MACE was 9.1% in all prediabetic patients and 3% in NG-patients. In prediabetic patients, current-metformin-users presented a significantly lower rate of MACE compared to prediabetic patients never-metformin-users. In addition, prediabetic patients showed higher inflammatory tone and leptin to adiponectin ratio in pericoronary fat compared to NG-patients (P < 0.001). Prediabetic never-metformin-users showed higher inflammatory tone and leptin to adiponectin ratio in pericoronary fat compared to current-metformin-users (P < 0.001). Remarkably, inflammatory tone and leptin to adiponectin ratio was significantly related to the MACE during the 12-months follow-up. Conclusion Prediabetes increase inflammatory burden in pericoronary adipose tissue. Metformin by reducing inflammatory tone and leptin to adiponectin ratio in pericoronary fat may improve prognosis in prediabetic patients with AMI. Trial registration Clinical Trial NCT03360981, Retrospectively Registered 7 January 2018

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