title: Poor implementation of cardiac rehabilitation despite broad dissemination of coronary interventions for acute myocardial infarction in Japan: a nationwide survey.
abstract: BACKGROUND
  The implementation of cardiac rehabilitation (CR) after acute myocardial infarction (AMI) has not been fully investigated in Japan, so a nationwide survey of hospitals was conducted.
  
  
  RESULTS
  Questionnaires were sent in 2004 to a total of 1,875 hospitals in Japan, including all the 859 Japanese Circulation Society (JCS)-authorized cardiology-training hospitals (THs), 311 JCS-associated hospitals (AH), and 705 randomly sampled non-THs (NTHs). The response rate was 59% (1,106/1,875). The percentages of hospitals treating hospitalized AMI patients were 97% in 526 TH, 85% in 194 AH, and 20% in 339 NTH. Although the rates of implementation of emergency percutaneous coronary intervention were very high (92%, 56%, and 4%, respectively), the rates of implementation of recovery phase CR were low (20%, 8%, and 2%, respectively). In addition, patient education programs (23%, 13% and 2%) and formulated exercise prescriptions based on exercise testing (16%, 7% and 1%) were poorly implemented. More importantly, only 9%, 2% and 0% of these hospitals had outpatient CR programs. From these data, the nationwide participation rate in outpatient CR after AMI in Japan was estimated to be only 3.8-7.6%.
  
  
  CONCLUSIONS
  This first nationwide survey demonstrated that, in contrast to the broad dissemination of acute phase invasive treatment for AMI, the implementation of recovery phase CR, especially outpatient CR, is extremely poor in Japan. In addition, patient education programs and exercise prescription based on exercise testing are only poorly implemented.
authors.affiliation: Division of Cardiology, National Cardiovascular Center, Suita, Japan. ygoto@hsp.ncvc.go.jp
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Goto
authors.forename: Muneyasu
authors.initials: M
authors.lastname: Saito
authors.forename: Toshiji
authors.initials: T
authors.lastname: Iwasaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kohzuki
authors.forename: Kenji
authors.initials: K
authors.lastname: Ueshima
authors.forename: Shigeru
authors.initials: S
authors.lastname: Makita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Adachi
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Yokoi
authors.forename: Kazuto
authors.initials: K
authors.lastname: Omiya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mikouchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokoyama
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data / Q000639:trends; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data / Q000639:trends; D005081:Exercise Therapy / Q000706:statistics & numerical data / Q000639:trends; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007564:Japan; D009203:Myocardial Infarction / Q000534:rehabilitation* / Q000628:therapy; D010353:Patient Education as Topic / Q000706:statistics & numerical data / Q000639:trends*