Journal CME October 2025: Factors influencing active participation in cardiac rehabilitation among patients with cardiovascular disease: A nationwide cohort study-PM R - 2025 - Kim

PM R - 2025 - Kim - Factors influencing active participation

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This nationwide Korean cohort study investigated factors influencing active participation in cardiac rehabilitation (CR) among patients with cardiovascular disease (CVD), utilizing the Korean National Health Insurance Database. Despite CR’s proven benefits in improving exercise capacity, quality of life, and long-term outcomes, participation rates remain low globally and in Korea.<br /><br />The analysis included 22,419 patients who underwent coronary revascularization at designated CR institutions in 2019. "Substantial CR" participation was defined as receiving CR therapy or evaluation in outpatient settings, indicating active patient engagement. Only 21.4% participated in substantial CR.<br /><br />Key findings from multivariable logistic regression showed that lower participation rates were significantly associated with female gender, older age (especially ≥70 years), rural residence, and lower income levels, including Medicaid recipients. Patients with severe registered disabilities (physical, brain, or mental), diabetes, musculoskeletal disorders, low physical activity levels, and being underweight had reduced participation. Notably, patients who were readmitted within 28 days post-revascularization or had CVD recurrence within 10 years had markedly lower CR involvement.<br /><br />Barriers to participation appear multifactorial: socioeconomic issues (e.g., geographic access, financial burdens despite insurance coverage), medical comorbidities affecting physical ability, and lifestyle factors. Women’s lower participation may be linked to social and psychological barriers; older adults face frailty and access issues; rural patients are limited by fewer local CR facilities; and disabled or musculoskeletal-compromised patients have physical limitations for exercise-based programs. Additionally, patients at higher risk due to recurrence or comorbidities paradoxically engage less in CR, highlighting a critical gap.<br /><br />The study recommends tailored strategies such as home-based or hybrid CR models to improve accessibility and accommodate patient-specific limitations, enhanced education and referral processes, and policies addressing socioeconomic barriers. Limitations include lack of data on patient motivation, severity of symptoms, detailed CR session adherence, and geographic accessibility measures. Future research should explore effects of CR participation on clinical outcomes further.<br /><br />In summary, CR participation is influenced by demographic, socioeconomic, and medical factors, necessitating targeted interventions to increase uptake, especially among high-risk and disadvantaged groups.

Keywords

cardiac rehabilitation

cardiovascular disease

Korean National Health Insurance Database

coronary revascularization

participation rates

socioeconomic factors

comorbidities

rural residence

gender disparities

home-based cardiac rehabilitation