Poor implementation of cardiac rehabilitation despite broad dissemination of coronary interventions for acute myocardial infarction in Japan: a nationwide survey.
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.
Goto
Yoichi
Y
Division of Cardiology, National Cardiovascular Center, Suita, Japan. ygoto@hsp.ncvc.go.jp
Saito
Muneyasu
M
Iwasaka
Toshiji
T
Daida
Hiroyuki
H
Kohzuki
Masahiro
M
Ueshima
Kenji
K
Makita
Shigeru
S
Adachi
Hitoshi
H
Yokoi
Hiroyoshi
H
Omiya
Kazuto
K
Mikouchi
Hiroshi
H
Yokoyama
Hiroyuki
H
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*