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Original research
Outpatient cardiac rehabilitation dose after acute coronary syndrome in a nationwide cohort
  1. Koshiro Kanaoka1,
  2. Yoshitaka Iwanaga1,
  3. Michikazu Nakai1,
  4. Yuichi Nishioka2,
  5. Tomoya Myojin2,
  6. Shinichiro Kubo2,
  7. Katsuki Okada3,
  8. Tsunenari Soeda4,
  9. Tatsuya Noda2,
  10. Yasushi Sakata5,
  11. Yoshihiro Miyamoto1,
  12. Yoshihiko Saito4,
  13. Tomoaki Imamura2
  1. 1 Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
  2. 2 Department of Public Health, Nara Medical University, Kashihara, Japan
  3. 3 Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Japan
  4. 4 Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
  5. 5 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
  1. Correspondence to Dr Tomoaki Imamura, Department of Public Heath, Nara Medical University, Kashihara, Japan; imamurat{at}


Objective Cardiac rehabilitation (CR) is effective in patients with acute coronary syndrome (ACS); however, CR programmes have not been fully implemented. This study aimed to reveal the current practice of outpatient CR and the dose–effect relationship of CR in real-world settings.

Methods We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with ACS who underwent percutaneous coronary intervention between April 2014 and March 2018 were included. We analysed the implementation rate and dose of outpatient CR and the association between dose and outcomes.

Results Out of 202 320 patients who underwent percutaneous coronary intervention for ACS, a total of 20 444 (10%) underwent outpatient CR. The median (IQR) number of total CR sessions was 9 (3–17), and the median (IQR) duration for each session was 60 (42–60) min. Patients were divided into four groups according to the total number of sessions (≤9 times or ≥10 times) and the duration per session (<50 min or ≥50 min). Compared with the low-number/short-duration group, the adjusted HR for all-cause mortality was 1.00 (95% CI 0.80 to 1.24, p=0.97) in the low-number/long-duration group, 0.63 (95% CI 0.46 to 0.87, p=0.005) in the high-number/short-duration group and 0.74 (95% CI 0.60 to 0.92, p=0.008) in the high-number/long-duration group, respectively.

Conclusion We found that the participation rate for outpatient CR after ACS was low and the doses of sessions vary in real-world settings. A higher number of total sessions of outpatient CR is associated with a better prognosis irrespective of the session’s duration.

  • cardiac rehabilitation
  • percutaneous coronary intervention
  • acute coronary syndrome

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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  • Contributors KK and YSai conceived the study. TI obtained research funding. KK, MN, YN, TM, SK and TN managed the data. MN, KO, TS, YSak and YM provided statistical advice on study design and analysis. KK drafted the manuscript, and all authors contributed substantially to its revision. All authors agree with the content of the manuscript. TI accepts responsibility for the overall content as the guarantor.

  • Funding This research was funded by Labor Research Grant (grant number: 19FA1002) from the Ministry of Health, Labour and Welfare, Japan.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.