Ann Rehabil Med.  2019 Jun;43(3):355-356. 10.5535/arm.2019.43.3.355.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea [Online only]

• Kim C
• Sung J
• Lee JH
• Kim WS
• Lee GJ
• Jee S
• Jung IY
• Rah UW
• Kim BO
• Choi KH
• Kwon BS
• Yoo SD
• Bang HJ
• Shin HI
• Kim YW
• Jung H
• Kim EJ
• Lee JH
• Jung IH
• Jung JS
• Lee JY
• Han JY
• Han EY
• Won YH
• Han W
• Baek S
• Joa KL
• Lee SJ
• Kim AR
• Lee SY
• Kim J
• Choi HE
• Lee BJ
• Kim S

• KMID: 2453928
• DOI: http://doi.org/10.5535/arm.2019.43.3.355

Abstract

OBJECTIVE
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 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 three 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.
METHODS
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 33 authors"”primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two 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, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular 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.

Keyword

Acute coronary syndrome; Cardiac rehabilitation; Mortality; Clinical practice guidelines; Secondary prevention

MeSH Terms

Acute Coronary Syndrome
Cardiovascular Diseases
Cause of Death
Consultants
Coronary Disease
Delivery of Health Care
Heart
Hospitals, General
Hospitals, University
Humans
Insurance Benefits
Korea*
Life Style
Methods
Mortality
Myocardial Infarction
Nutritionists
Physical Therapists
Preventive Medicine
Recurrence
Rehabilitation*
Secondary Prevention
Specialization
Sports Medicine
Surgeons

Reference

1. Shin HY, Lee JY, Song J, Lee S, Lee J, Lim B, et al. Cause-of-death statistics in the Republic of Korea, 2014. J Korean Med Assoc. 2016; 59:221–32.

2. Lee SW, Kim HC, Lee HS, Suh I. Thirty-year trends in mortality from cardiovascular diseases in Korea. Korean Circ J. 2015; 45:202–9.

3. Korean Statistical Information Service. Cause of death statistics. Daejeon: Statistics Korea;2016.

4. Canadian Association of Cardiac Rehabilitation. Canadian guidelines for cardiac rehabilitation and cardiovascular disease prevention: translating knowledge into action. Winnipeg: Canadian Association of Cardiac Rehabilitation;2009.

5. Scottish Intercollegiate Guidelines Network. Cardiac rehabilitation: a national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network;2017.

6. National Institute for Health and Care Excellence. Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease (CG172). London: National Institute for Health and Care Excellence;2013.

7. Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update. A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011; 124:2458–73.

8. JCS Joint Working Group. Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012). Circ J. 2014; 78:2022–93.

9. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37:2315–81.

10. Steering Committee for Clinical Practice Guideline. Korean Appraisal of Guidelines for Research & Evaluation II. Seoul: Ministry of Health & Welfare, Korean Academy of Medical Science;2010.

11. Cardiac Rehabilitation Guideline Panel. Cardiac rehabilitation as secondary prevention. Am Fam Physician. 1995; 52:2257–64.

12. Balady GJ, Ades PA, Bittner VA, Franklin BA, Gordon NF, Thomas RJ, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation. 2011; 124:2951–60.

13. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012; 33:1635–701.

14. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016; 67:1–12.

15. Sumner J, Harrison A, Doherty P. The effectiveness of modern cardiac rehabilitation: a systematic review of recent observational studies in non-attenders versus attenders. PLoS One. 2017; 12:e0177658.

16. Goodwin L, Ostuzzi G, Khan N, Hotopf MH, Moss-Morris R. Can we identify the active ingredients of behaviour change interventions for coronary heart disease patients? A systematic review and metaanalysis. PLoS One. 2016; 11:e0153271.

17. Kim C, Kim DY, Moon CJ. Prognostic influences of cardiac rehabilitation in Korean acute myocardial infarction patients. Ann Rehabil Med. 2011; 35:375–80.

18. Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014; (12):CD011273.

19. Shepherd CW, While AE. Cardiac rehabilitation and quality of life: a systematic review. Int J Nurs Stud. 2012; 49:755–71.

20. Abell B, Glasziou P, Hoffmann T. The contribution of individual exercise training components to clinical outcomes in randomised controlled trials of cardiac rehabilitation: a systematic review and meta-regression. Sports Med Open. 2017; 3:19.

21. van Halewijn G, Deckers J, Tay HY, van Domburg R, Kotseva K, Wood D. Lessons from contemporary trials of cardiovascular prevention and rehabilitation: a systematic review and meta-analysis. Int J Cardiol. 2017; 232:294–303.

22. Chan E, Giallauria F, Vigorito C, Smart NA. Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis. Monaldi Arch Chest Dis. 2016; 86:759.

23. Pandey A, Parashar A, Kumbhani D, Agarwal S, Garg J, Kitzman D, et al. Exercise training in patients with heart failure and preserved ejection fraction: metaanalysis of randomized control trials. Circ Heart Fail. 2015; 8:33–40.

24. Haykowsky M, Scott J, Esch B, Schopflocher D, Myers J, Paterson I, et al. A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling. Trials. 2011; 12:92.

25. Zhang YM, Lu Y, Tang Y, Yang D, Wu HF, Bian ZP, et al. The effects of different initiation time of exercise training on left ventricular remodeling and cardiopulmonary rehabilitation in patients with left ventricular dysfunction after myocardial infarction. Disabil Rehabil. 2016; 38:268–76.

26. Oldridge N. Exercise-based cardiac rehabilitation in patients with coronary heart disease: meta-analysis outcomes revisited. Future Cardiol. 2012; 8:729–51.

27. Kim C, Bang HJ, Kim JH, Sohn MK, Yang CY, Lee SG, et al. Recommendations for establishing cardiac rehabilitation programs: facility, equipment and staff. The Korean Society of Cardiac Rehabilitation (KSCR) position statement. J Korean Acad Rehabil Med. 2010; 34:491–7.

28. Jones J, Buckley JP, Furze G, Doherty P, Speck L, Connolly S, et al. The BACPR standards and core components for cardiovascular prevention and rehabilitation 2012. London: British Association for Cardiovascular Prevention and Rehabilitation;2012.

29. Clark AM, Catto S, Bowman G, Macintyre PD. Design matters in secondary prevention: individualization and supervised exercise improves the effectiveness of cardiac rehabilitation. Eur J Cardiovasc Prev Rehabil. 2011; 18:761–9.

30. Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev. 2015; (3):CD010523.

31. Hill K, Walwyn R, Camidge D, Murray J, Meads D, Reynolds G, et al. A randomized feasibility trial of a new lifestyle referral assessment versus usual assessment in an acute cardiology setting. J Cardiovasc Nurs. 2016; 31:507–516.

32. Weibel L, Massarotto P, Hediger H, Mahrer-Imhof R. Early education and counselling of patients with acute coronary syndrome. A pilot study for a randomized controlled trial. Eur J Cardiovasc Nurs. 2016; 15:213–22.

33. Fors A, Swedberg K, Ulin K, Wolf A, Ekman I. Effects of person-centred care after an event of acute coronary syndrome: two-year follow-up of a randomized controlled trial. Int J Cardiol. 2017; 249:42–7.

34. Lesperance F, Frasure-Smith N. Depression in patients with cardiac disease: a practical review. J Psychosom Res. 2000; 48:379–91.

35. Carney RM, Freedland KE. Depression, mortality, and medical morbidity in patients with coronary heart disease. Biol Psychiatry. 2003; 54:241–7.

36. Frasure-Smith N, Lesperance F. Recent evidence linking coronary heart disease and depression. Can J Psychiatry. 2006; 51:730–7.

37. Gehi A, Haas D, Pipkin S, Whooley MA. Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study. Arch Intern Med. 2005; 165:2508–13.

38. Ades PA, Waldmann ML, McCann WJ, Weaver SO. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med. 1992; 152:1033–5.

39. Glazer KM, Emery CF, Frid DJ, Banyasz RE. Psychological predictors of adherence and outcomes among patients in cardiac rehabilitation. J Cardiopulm Rehabil. 2002; 22:40–6.

40. Frasure-Smith N, Lesperance F, Gravel G, Masson A, Juneau M, Talajic M, et al. Depression and healthcare costs during the first year following myocardial infarction. J Psychosom Res. 2000; 48:471–8.

41. Shibeshi WA, Young-Xu Y, Blatt CM. Anxiety worsens prognosis in patients with coronary artery disease. J Am Coll Cardiol. 2007; 49:2021–7.

42. Murphy BM, Higgins RO, Jackson AC. Anxiety, depression, and psychological adjustment after an acute cardiac event. In : Alvarenga ME, Byrne DG, editors. Handbook of psychocardiology. Singapore: Springer;2015. p. 1–21.

43. Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2017; 4:CD002902.

44. Klainin-Yobas P, Ng SH, Stephen PDM, Lau Y. Efficacy of psychosocial interventions on psychological outcomes among people with cardiovascular diseases: a systematic review and meta-analysis. Patient Educ Couns. 2016; 99:512–21.

45. von Kanel R, Barth J, Princip M, Meister-Langraf RE, Schmid JP, Znoj H, et al. Early psychological counseling for the prevention of posttraumatic stress induced by acute coronary syndrome: the MI-SPRINT randomized controlled trial. Psychother Psychosom. 2018; 87:75–84.

46. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2013.

47. American Association of Cardiovascular & Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. Champaign, IL: Human Kinetics;2013.

48. Balady GJ, Leitschuh ML, Jacobs AK, Merrell D, Weiner DA, Ryan TJ. Safety and clinical use of exercise testing one to three days after percutaneous transluminal coronary angioplasty. Am J Cardiol. 1992; 69:1259–64.

49. Horgan J, Bethell H, Carson P, Davidson C, Julian D, Mayou RA, et al. Working party report on cardiac rehabilitation. Br Heart J. 1992; 67:412–8.

50. Goble AJ, Worcester MC. Best practice guidelines for cardiac rehabilitation and secondary prevention. Melbourne, Australia: Department of Human Services;1999.

51. Wright DJ, Khan KM, Gossage EM, Saltissi S. Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test. Clin Rehabil. 2001; 15:119–24.

52. Tallaj JA, Sanderson B, Breland J, Adams C, Schumann C, Bittner V. Assessment of functional outcomes using the 6-minute walk test in cardiac rehabilitation: comparison of patients with and without left ventricular dysfunction. J Cardiopulm Rehabil. 2001; 21:221–4.

53. Verrill DE, Barton C, Beasley W, Lippard M, King CN. Six-minute walk performance and quality of life comparisons in North Carolina cardiac rehabilitation programs. Heart Lung. 2003; 32:41–51.

54. Bellet RN, Adams L, Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness. A systematic review. Physiotherapy. 2012; 98:277–86.

55. Nogueira PA, Leal AC, Pulz C, Nogueira ID, Filho JA. Clinical reliability of the 6 minute corridor walk test performed within a week of a myocardial infarction. Int Heart J. 2006; 47:533–40.

56. Hanson LC, McBurney H, Taylor NF. The retest reliability of the six-minute walk test in patients referred to a cardiac rehabilitation programme. Physiother Res Int. 2012; 17:55–61.

57. Harris KM, Anderson DR, Landers JD, Emery CF. Utility of walk tests in evaluating functional status among participants in an outpatient cardiac rehabilitation program. J Cardiopulm Rehabil Prev. 2017; 37:329–33.

58. Goto Y. Current state of cardiac rehabilitation in Japan. Prog Cardiovasc Dis. 2014; 56:557–62.

59. Im HW, Baek S, Jee S, Ahn JM, Park MW, Kim WS. Barriers to outpatient hospital-based cardiac rehabilitation in Korean patients with acute coronary syndrome. Ann Rehabil Med. 2018; 42:154–65.

60. Ades PA, Keteyian SJ, Wright JS, Hamm LF, Lui K, Newlin K, et al. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clin Proc. 2017; 92:234–42.

61. Karmali KN, Davies P, Taylor F, Beswick A, Martin N, Ebrahim S. Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev. 2014; (6):CD007131.

62. Cossette S, Frasure-Smith N, Dupuis J, Juneau M, Guertin MC. Randomized controlled trial of tailored nursing interventions to improve cardiacrehabilitation enrollment. Nurs Res. 2012; 61:111–20.

63. Hillebrand T, Frodermann H, Lehr D, Wirth A. Increased participation in coronary groups by means of an outpatient care program. Herz Kreislauf. 1995; 27:346–9.

64. Jolly K, Bradley F, Sharp S, Smith H, Thompson S, Kinmonth AL, et al. Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southampton heart integrated care project (SHIP). The SHIP Collaborative Group. BMJ. 1999; 318:706–11.

65. Price JA. A pilot trial of a coaching intervention designed to increase women’s attendance at cardiac rehabilitation intake. [dissertation]. Toronto, Canada: University of Toronto;2012.

66. Pack QR, Mansour M, Barboza JS, Hibner BA, Mahan MG, Ehrman JK, et al. An early appointment to outpatient cardiac rehabilitation at hospital discharge improves attendance at orientation: a randomized, single-blind, controlled trial. Circulation. 2013; 127:349–55.

67. Wyer S, Earll L, Joseph S, Harrison J, Giles M, Johnston M. Increasing attendance at a cardiac rehabilitation programme: an intervention study using the Theory of Planned Behaviour. Coron Health Care. 2001; 5:154–9.

68. Arrigo I, Brunner-LaRocca H, Lefkovits M, Pfisterer M, Hoffmann A. Comparative outcome one year after formal cardiac rehabilitation: the effects of a randomized intervention to improve exercise adherence. Eur J Cardiovasc Prev Rehabil. 2008; 15:306–11.

69. Duncan KA, Pozehl B. Staying on course: the effects of an adherence facilitation intervention on home exercise participation. Prog Cardiovasc Nurs. 2002; 17:59–65. , 71.

70. Sniehotta FF, Scholz U, Schwarzer R. Action plans and coping plans for physical exercise: a longitudinal intervention study in cardiac rehabilitation. Br J Health Psychol. 2006; 11(Pt 1):23–37.

71. Reid RD, Morrin LI, Higginson LA, Wielgosz A, Blanchard C, Beaton LJ, et al. Motivational counselling for physical activity in patients with coronary artery disease not participating in cardiac rehabilitation. Eur J Prev Cardiol. 2012; 19:161–6.

72. Grace SL, Midence L, Oh P, Brister S, Chessex C, Stewart DE, et al. Cardiac rehabilitation program adherence and functional capacity among women: a randomized controlled trial. Mayo Clin Proc. 2016; 91:140–8.

73. Lynggaard V, Nielsen CV, Zwisler AD, Taylor RS, May O. The patient education: learning and coping strategies. Improves adherence in cardiac rehabilitation (LC-REHAB): a randomised controlled trial. Int J Cardiol. 2017; 236:65–70.

74. Grace SL, Chessex C, Arthur H, Chan S, Cyr C, Dafoe W, et al. Systematizing inpatient referral to cardiac rehabilitation 2010: Canadian Association of Cardiac Rehabilitation and Canadian Cardiovascular Society joint position paper endorsed by the Cardiac Care Network of Ontario. Can J Cardiol. 2011; 27:192–9.

75. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004; 116:682–92.

76. van den Berg-Emons RJ, Bussmann JB, Balk AH, Stam HJ. Factors associated with the level of movement-related everyday activity and quality of life in people with chronic heart failure. Phys Ther. 2005; 85:1340–8.

77. ter Hoeve N, Huisstede BM, Stam HJ, van Domburg RT, Sunamura M, van den Berg-Emons RJ. Does cardiac rehabilitation after an acute cardiac syndrome lead to changes in physical activity habits? Systematic review. Phys Ther. 2015; 95:167–79.

78. Cha S, Park JJ, Kim S, Ahn HY, Han K, Lee Y, et al. Need for systematic efforts to modify health-related behaviors after acute myocardial infarction in Korea. Circ J. 2018; 82:2523–9.

79. Aldcroft SA, Taylor NF, Blackstock FC, O’Halloran PD. Psychoeducational rehabilitation for health behavior change in coronary artery disease: a systematic review of controlled trials. J Cardiopulm Rehabil Prev. 2011; 31:273–81.

80. Tingstrom PR, Kamwendo K, Bergdahl B. Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease. Eur J Cardiovasc Nurs. 2005; 4:324–30.

81. Carlson JJ, Johnson JA, Franklin BA, VanderLaan RL. Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation. Am J Cardiol. 2000; 86:17–23.

82. Izawa KP, Watanabe S, Omiya K, Hirano Y, Oka K, Osada N, et al. Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: a randomized, controlled trial. Am J Phys Med Rehabil. 2005; 84:313–21.

83. Fournier M, Radel R, Bailly L, Pradier C, Fabre R, Fuch A, et al. “As du Coeur” study: a randomized controlled trial on physical activity maintenance in cardiovascular patients. BMC Cardiovasc Disord. 2018; 18:77.

84. Ter Hoeve N, Sunamura M, Stam HJ, Boersma E, Geleijnse ML, van Domburg RT, et al. Effects of two behavioral cardiac rehabilitation interventions on physical activity: a randomized controlled trial. Int J Cardiol. 2018; 255:221–8.

85. Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, et al. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation. 2015; 131:927–64.

86. Hansen D, Dendale P, Leenders M, Berger J, Raskin A, Vaes J, et al. Reduction of cardiovascular event rate: different effects of cardiac rehabilitation in CABG and PCI patients. Acta Cardiol. 2009; 64:639–44.

87. Hedback B, Perk J, Hornblad M, Ohlsson U. Cardiac rehabilitation after coronary artery bypass surgery: 10-year results on mortality, morbidity and readmissions to hospital. J Cardiovasc Risk. 2001; 8:153–8.

88. Aldahash R, Al Dera HS. Physical therapy program improves the physiological impact towards better quality of life and low cardiac risk factors in patients following coronary artery bypass grafting: systematic review. Acta Medica Int. 2016; 3:185–95.

89. Kim SY, Oh JK, Youn JH, Kim YJ. The effect of cardiac rehabilitation I phase program on physical capacity after coronary artery bypass graft surgery. Korean J Sports Med. 2012; 30:85–91.

90. Hamm LF, Sanderson BK, Ades PA, Berra K, Kaminsky LA, Roitman JL, et al. Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update. Position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev. 2011; 31:2–10.

91. Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016; (1):CD001800.

92. Brown A, Taylor R, Noorani H, Stone J, Skidmore B. Exercise-based cardiac rehabilitation programs for coronary artery disease: a systematic clinical and economic review. Ottawa, Canada: Canadian Coordinating Office for Health Technology Assessment;2003.

93. Chen YC, Tsai JC, Liou YM, Chan P. Effectiveness of endurance exercise training in patients with coronary artery disease: a meta-analysis of randomised controlled trials. Eur J Cardiovasc Nurs. 2017; 16:397–408.

94. Liou K, Ho S, Fildes J, Ooi SY. High intensity interval versus moderate intensity continuous training in patients with coronary artery disease: a meta-analysis of physiological and clinical parameters. Heart Lung Circ. 2016; 25:166–74.

95. Choi HY, Han HJ, Choi JW, Jung HY, Joa KL. Superior effects of high-intensity interval training compared to conventional therapy on cardiovascular and psychological aspects in myocardial infarction. Ann Rehabil Med. 2018; 42:145–53.

96. Kim C, Choi HE, Lim MH. Effect of high interval training in acute myocardial infarction patients with drug-eluting stent. Am J Phys Med Rehabil. 2015; 94(10 Suppl 1):879–86.

97. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007; 116:572–84.

98. Hollings M, Mavros Y, Freeston J, Fiatarone Singh M. The effect of progressive resistance training on aerobic fitness and strength in adults with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2017; 24:1242–59.

99. Karagiannis C, Savva C, Mamais I, Efstathiou M, Monticone M, Xanthos T. Eccentric exercise in ischemic cardiac patients and functional capacity: a systematic review and meta-analysis of randomized controlled trials. Ann Phys Rehabil Med. 2017; 60:58–64.

100. Xanthos PD, Gordon BA, Kingsley MI. Implementing resistance training in the rehabilitation of coronary heart disease: a systematic review and meta-analysis. Int J Cardiol. 2017; 230:493–508.

101. Kavanagh T, Mertens DJ, Hamm LF, Beyene J, Kennedy J, Corey P, et al. Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation. Circulation. 2002; 106:666–71.

102. Kavanagh T, Mertens DJ, Hamm LF, Beyene J, Kennedy J, Corey P, et al. Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation. J Am Coll Cardiol. 2003; 42:2139–43.

103. Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987; 106:793–800.

104. Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, Lee KL, Bengtson JR, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991; 325:849–53.

105. Vanhees L, Fagard R, Thijs L, Staessen J, Amery A. Prognostic significance of peak exercise capacity in patients with coronary artery disease. J Am Coll Cardiol. 1994; 23:358–63.

106. Kokkinos P, Myers J, Kokkinos JP, Pittaras A, Narayan P, Manolis A, et al. Exercise capacity and mortality in black and white men. Circulation. 2008; 117:614–22.

107. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104:1694–740.

108. Kim C, Moon CJ, Lim MH. Safety of monitoring exercise for early hospital-based cardiac rehabilitation. Ann Rehabil Med. 2012; 36:262–7.

109. Claes J, Buys R, Budts W, Smart N, Cornelissen VA. Longer-term effects of home-based exercise interventions on exercise capacity and physical activity in coronary artery disease patients: a systematic review and meta-analysis. Eur J Prev Cardiol. 2017; 24:244–56.

110. Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2017; 6:CD007130.

111. Huang K, Liu W, He D, Huang B, Xiao D, Peng Y, et al. Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: a systematic review and meta-analysis. Eur J Prev Cardiol. 2015; 22:959–71.

112. McClure T, Haykowsky MJ, Schopflocher D, Hsu ZY, Clark AM. Home-based secondary prevention programs for patients with coronary artery disease: a meta-analysis of effects on anxiety. J Cardiopulm Rehabil Prev. 2013; 33:59–67.

113. Heron N, Kee F, Donnelly M, Cardwell C, Tully MA, Cupples ME. Behaviour change techniques in homebased cardiac rehabilitation: a systematic review. Br J Gen Pract. 2016; 66:e747. –57.

114. Lee YH, Hur SH, Sohn J, Lee HM, Park NH, Cho YK, et al. Impact of home-based exercise training with wireless monitoring on patients with acute coronary syndrome undergoing percutaneous coronary intervention. J Korean Med Sci. 2013; 28:564–8.

115. Chung H, Ko H, Thap T, Jeong C, Noh SE, Yoon KH, et al. Smartphone-based cardiac rehabilitation program: feasibility study. PLoS One. 2016; 11:e0161268.

116. Lee H, Chung H, Ko H, Jeong C, Noh SE, Kim C, et al. Dedicated cardiac rehabilitation wearable sensor and its clinical potential. PLoS One. 2017; 12:e0187108.

117. Rich MW, Bosner MS, Chung MK, Shen J, McKenzie JP. Is age an independent predictor of early and late mortality in patients with acute myocardial infarction? Am J Med. 1992; 92:7–13.

118. Ades PA, Savage PD, Tischler MD, Poehlman ET, Dee J, Niggel J. Determinants of disability in older coronary patients. Am Heart J. 2002; 143:151–6.

119. Pasquali SK, Alexander KP, Peterson ED. Cardiac rehabilitation in the elderly. Am Heart J. 2001; 142:748–55.

120. Audelin MC, Savage PD, Ades PA. Exercise-based cardiac rehabilitation for very old patients (> or =75 years): focus on physical function. J Cardiopulm Rehabil Prev. 2008; 28:163–73.

121. Yamamoto S, Hotta K, Ota E, Mori R, Matsunaga A. Effects of resistance training on muscle strength, exercise capacity, and mobility in middle-aged and elderly patients with coronary artery disease: a metaanalysis. J Cardiol. 2016; 68:125–34.

122. Kim JH. Effects of cardiac rehabilitation in elderly patients after myocardial infarction. J Korea Acad-Ind Coop Soc. 2016; 17:464–71.

123. British Association for Cardiovascular Prevention and Rehabilitation. The BACPR standards and core components for cardiovascular disease prevention and rehabilitation 2017. London: British Cardiovascular Society;2017.

124. Ferrier S, Blanchard CM, Vallis M, Giacomantonio N. Behavioural interventions to increase the physical activity of cardiac patients: a review. Eur J Cardiovasc Prev Rehabil. 2011; 18:15–32.

125. Tierney S, Mamas M, Skelton D, Woods S, Rutter MK, Gibson M, et al. What can we learn from patients with heart failure about exercise adherence? A systematic review of qualitative papers. Health Psychol. 2011; 30:401–10.

126. Anderson L, Brown JP, Clark AM, Dalal H, Rossau HK, Bridges C, et al. Patient education in the management of coronary heart disease. Cochrane Database Syst Rev. 2017; 6:CD008895.

127. Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014; (11):CD000011.

128. Chase JA, Bogener JL, Ruppar TM, Conn VS. The effectiveness of medication adherence interventions among patients with coronary artery disease: a meta-analysis. J Cardiovasc Nurs. 2016; 31:357–66.

129. Adler AJ, Martin N, Mariani J, Tajer CD, Owolabi OO, Free C, et al. Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2017; 4:CD011851.

130. Gandapur Y, Kianoush S, Kelli HM, Misra S, Urrea B, Blaha MJ, et al. The role of mHealth for improving medication adherence in patients with cardiovascular disease: a systematic review. Eur Heart J Qual Care Clin Outcomes. 2016; 2:237–44.

131. Gandhi S, Chen S, Hong L, Sun K, Gong E, Li C, et al. Effect of mobile health interventions on the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Can J Cardiol. 2017; 33:219–31.

132. Zullig LL, Ramos K, Bosworth HB. Improving medication adherence in coronary heart disease. Curr Cardiol Rep. 2017; 19:113.

133. Barth J, Jacob T, Daha I, Critchley JA. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database Syst Rev. 2015; (7):CD006886.

134. Kotb A, Hsieh S, Wells GA. The effect of telephone support interventions on coronary artery disease (CAD) patient outcomes during cardiac rehabilitation: a systematic review and meta-analysis. PLoS One. 2014; 9:e96581.

135. Rigotti NA, Clair C, Munafo MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2012; (5):CD001837.

136. Rice VH, Hartmann-Boyce J, Stead LF. Nursing interventions for smoking cessation. Cochrane Database Syst Rev. 2013; (8):CD001188.

137. Stead LF, Koilpillai P, Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev. 2015; (10):CD009670.

138. Franck C, Filion KB, Eisenberg MJ. Smoking cessation in patients with acute coronary syndrome. Am J Cardiol. 2018; 121:1105–11.

139. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129(25 Suppl 2):S76–99.

140. National Heart Foundation of Australia; Cardiac Society of Australia and New Zealand. Reducing risk in heart disease: an expert guide to clinical practice for secondary prevention of coronary heart disease. Melbourne. Australia: National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand;2002.

141. Committee of Clinical Practice Guideline of the Korean Society of Lipid and Atherosclerosis. Korean Guidelines for the management of dyslipidemia. 4th ed. Seoul: Korean Society of Lipid and Atherosclerosis;2018.

142. The Committee of Hypertension Clinical Guideline of Korean Academy of Medical Sciences. Evidencebased recommendations for hypertension in primary care. Seoul: Korean Academy of Medical Sciences, Korea Centers for Disease Control & Prevention;2018.

143. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010; 92:1189–96.

144. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013; 368:1279–90.

145. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018; 378:e34.

146. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999; 99:779–85.

147. Singh RB, Rastogi SS, Verma R, Laxmi B, Singh R, Ghosh S, et al. Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up. BMJ. 1992; 304:1015–9.

148. McGowan MP, Proulx S. Nutritional supplements and serum lipids: does anything work? Curr Atheroscler Rep. 2009; 11:470–6.

149. Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018; 7:CD003177.

150. Kotwal S, Jun M, Sullivan D, Perkovic V, Neal B. Omega 3 Fatty acids and cardiovascular outcomes: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012; 5:808–18.

151. Rizos EC, Elisaf MS. Does supplementation with omega-3 PUFAs add to the prevention of cardiovascular disease? Curr Cardiol Rep. 2017; 19:47.

152. Enns JE, Yeganeh A, Zarychanski R, Abou-Setta AM, Friesen C, Zahradka P, et al. The impact of omega-3 polyunsaturated fatty acid supplementation on the incidence of cardiovascular events and complications in peripheral arterial disease: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2014; 14:70.

153. Gong J, Qin X, Yuan F, Hu M, Chen G, Fang K, et al. Efficacy and safety of sugarcane policosanol on dyslipidemia: A meta-analysis of randomized controlled trials. Mol Nutr Food Res. 2018; 62.

154. Marazzi G, Campolongo G, Pelliccia F, Quattrino S, Vitale C, Cacciotti L, et al. Comparison of low-dose statin versus low-dose statin + Armolipid plus in high-intensity statin-intolerant patients with a previous coronary event and percutaneous coronary intervention (ADHERENCE Trial). Am J Cardiol. 2017; 120:893–7.

155. Xu K, Liu X, Li Y, Wang Y, Zang H, Guo L, et al. Safety and efficacy of policosanol in patients with high ontreatment platelet reactivity after drug-eluting stent implantation: two-year follow-up results. Cardiovasc Ther. 2016; 34:337–42.

156. Berthold HK, Unverdorben S, Degenhardt R, Bulitta M, Gouni-Berthold I. Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial. JAMA. 2006; 295:2262–9.

157. Ye Y, Li J, Yuan Z. Effect of antioxidant vitamin supplementation on cardiovascular outcomes: a metaanalysis of randomized controlled trials. PLoS One. 2013; 8:e56803.

158. Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women’s Health Study: a randomized controlled trial. JAMA. 2005; 294:56–65.

159. Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH. Beta-carotene supplementation and incidence of cancer and cardiovascular disease: the Women’s Health Study. J Natl Cancer Inst. 1999; 91:2102–6.

160. Loffredo L, Perri L, Di Castelnuovo A, Iacoviello L, De Gaetano G, Violi F. Supplementation with vitamin E alone is associated with reduced myocardial infarction: a meta-analysis. Nutr Metab Cardiovasc Dis. 2015; 25:354–63.

161. Myung SK, Ju W, Cho B, Oh SW, Park SM, Koo BK, et al. Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomized controlled trials. BMJ. 2013; 346:f10.

162. World Health Organization. mHealth: new horizons for health through mobile technologies. Geneva, Switzerland: World Health Organization;2011.

163. Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies. Washington, DC: Pew Research Center;2016.

164. Statista Inc. Mobile Internet - Statistics & Facts [Internet]. New York, NY: Statista Inc;2018. [cited 2019 Jun 1]. Available from: https://www.statista.com/topics/779/mobile-internet/.

165. Statista Inc. Number of mHealth app downloads worldwide from 2013 to 2017 (in billions) [Internet]. New York, NY: Statista Inc;c2019. [cited 2019 Jun 1]. Available from: https://www.statista.com/statistics/625034/mobile-health-app-downloads/.

166. Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P. Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol. 2015; 22:35–74.

167. Maddison R, Pfaeffli L, Whittaker R, Stewart R, Kerr A, Jiang Y, et al. A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial. Eur J Prev Cardiol. 2015; 22:701–9.

168. Butler L, Furber S, Phongsavan P, Mark A, Bauman A. Effects of a pedometer-based intervention on physical activity levels after cardiac rehabilitation: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2009; 29:105–14.

169. Verheijden Klompstra L, Jaarsma T, Stromberg A. Exergaming in older adults: a scoping review and implementation potential for patients with heart failure. Eur J Cardiovasc Nurs. 2014; 13:388–98.

170. Devi R, Powell J, Singh S. A web-based program improves physical activity outcomes in a primary care angina population: randomized controlled trial. J Med Internet Res. 2014; 16:e186.

171. Lear SA, Singer J, Banner-Lukaris D, Horvat D, Park JE, Bates J, et al. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the Internet. Circ Cardiovasc Qual Outcomes. 2014; 7:952–9.

172. Reid RD, Morrin LI, Beaton LJ, Papadakis S, Kocourek J, McDonnell L, et al. Randomized trial of an internet-based computer-tailored expert system for physical activity in patients with heart disease. Eur J Prev Cardiol. 2012; 19:1357–64.

173. Coorey GM, Neubeck L, Mulley J, Redfern J. Effectiveness, acceptability and usefulness of mobile applications for cardiovascular disease self-management: systematic review with meta-synthesis of quantitative and qualitative data. Eur J Prev Cardiol. 2018; 25:505–21.

174. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009; 119:3028–35.

175. Korean Nutrition Society. (2015) Dietary reference intakes for Koreans. Seoul: Korean Nutrition Society;2016.

176. He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002; 16:761–70.

177. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001; 344:3–10.

178. Zhang Z, Xu G, Liu D, Zhu W, Fan X, Liu X. Dietary fiber consumption and risk of stroke. Eur J Epidemiol. 2013; 28:119–30.

179. Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, et al. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ. 2013; 347:f6879.