Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome

Abstract

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Blood pressure, heart rate, and rate pressure product behavior during interval and continuous aerobic exercise (Comportamiento de la presión arterial, frecuencia cardíaca y doble producto durante el ejercicio aeróbico a intervalos y continuo)

“…Therefore, even with a low number of adverse events, it is not possible to observe the magnitude of response of these variables. It is important to highlight that in exercise programs for cardiac rehabilitation, recommended intensity ranges varying between 40% and 85% of the reserve heart rate (Kim et al, 2019); thus, the intensity range of the present study denotes less cardiovascular overload during its execution, meeting the recommendations of Kim et al (2019). Even Powell et al (2018) indicated no advantages, neither in relation to mortality nor in the number of hospitalizations for patients after cardiocirculatory events that included physical exercises in their rehabilitation routine when compared to those that did not.…”

Implementation of National Health Policy for the Prevention and Control of Cardiovascular Disease in South Korea: Regional-Local Cardio-Cerebrovascular Center and Nationwide Registry

“…Ideally, these centers should serve as vertical institutions that provide services ranging from acute care to health promotion and rehabilitation. 46) To eliminate or minimize the disparities in acute care and case fatalities between rural and urban areas, expansion of regional CCVCs and establishment of new local CCVCs are highly recommended.…”

Risk factors for acute pulmonary embolism in patients with off-pump coronary artery bypass grafting: implications for nursing

“…Therefore, patients with OPCABG can avoid injury to themselves under nonphysiological conditions while undergoing surgical treatment. 18 The effect of OPCABG on the coagulation system causing hypercoagulability must be considered. APE is a serious complication in patients with OPCABG.…”