Trends in Cardiac Rehabilitation Participation in Patients With Acute Myocardial Infarction: A 5-Year Nationwide Study in Korea

Background: Cardiac rehabilitation (CR) is a critical secondary prevention strategy for patients with acute myocardial infarction (AMI).Although CR has been covered by the National Health Insurance in Korea since 2017, real-world participation remains suboptimal.We assessed trends in CR participation over the past 5 years and identified factors associated with non-participation in treatment.Methods: This retrospective observational study analyzed data from the National Health Insurance Service claims database between 2018 and 2022.Patients aged 40 years who were hospitalized for AMI and received acute-phase interventions, such as thrombolysis, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG), were included.CR participation was defined as having at least one claim for education, assessment, or treatment services.Multivariable logistic regression was conducted to identify factors associated with non-participation in CR treatment, focusing on patients who received care at CR-providing institutions, to minimize confounding related to institutional availability.Results: In total, 109,436 patients were included.Overall participation rates in CR education, assessment, and treatment increased from 2018 to 2022.However, sustained participation in outpatient treatment remained low, with only 5.7% of patients in 2022 completing 11 treatment sessions.Factors associated with lower treatment participation included the absence of prior education and assessment, lower socioeconomic status, undergoing PCI rather than CABG, and receiving care at non-tertiary hospitals.Regional disparities and inadequate institutional infrastructure further contributed to reduced access to CR services. Conclusion:Although CR participation among patients with AMI in Korea has gradually increased, treatment continuity remains suboptimal.To enhance CR utilization, policy efforts