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1 Case Report : Asan Medical Center Cardiac Rehabilitation AACVPR ( KACVPR (

2 Backgrounds

3 PCI 2,395 consecutive patients in Minnesota (Mayo Clinic) Between1994 and 2008 Propensity score-matched analysis Propensity score stratification Regression adjustment with propensity score in a 3-month landmark analysis Median 6.3 years CR participation : 40% of patients Circulation. 2011;123:2344

4 PCI Relative mortality reduction (47%) Circulation. 2011;123:2344

5 CABG Patient mortality in the 12 years following enrolment into a pre-surgical cardiac rehabilitation programme. Mortality 19% reduction Clin Rehabil Dec 15. [Epub ahead of print]

6 Stable Coronary Artery Disease 1 native coronary artery stenosis of 75% by visual assessment amenable to PCI 12 months of exercise training (20 minutes of bicycle ergometry per day) Circulation. 2004;109:

7 Stable Coronary Artery Disease Clinical events (stroke, target vessel revascularization, PCI of a de novo lesion, or CABG) 88% 70% Circulation. 2004;109:

8 Acute Coronary Syndrome 18, patients OASIS 5 randomized trial Circulation. 2010;121:

9 Acute Coronary Syndrome Circulation. 2010;121:

10 The dose of cardiac rehabilitation Death MI 47% 22% 14% 31% 23% 12% Dose-response relationship!! Circulation. 2010;121:63-70

11 Peripheral Artery Disease Circulation 2012;125

12 Practice

13 PCI or CABG without comprehensive risk factor modifications is a sub-optimal therapeutic strategy. Psychosocial C Counseling li

14 Ideal Member Program Director Medical Director

15 Members

16 Target Population ALL suitable CHD patient Stable angina ACS ( UA, STEMI or NSTEMI following medical or surgical management.) Before and After revascularisation. Stable heart failure and cardiomyopathy Peripheral vascular disease Following valve surgery or ICD insertion High risk patients for primary prevention

17 Components Lifestyle - Physical activity and Exercise - Diet and Weight management - Smoking Cessation Education Exercise & fitness Risk Factor Management - Hypertension - Diabetes - Dyslipidemia -Smoking - Obesity Psychosocial stress management Cardio-protective drug therapy Long Term Management

18 Credibility

19 Flow, First Step Second Step (ITP) (A,B,C,D),, Third Step

20 Determinating factor 100 Risk factor MI LM CTO Multivessel(CABG) / / HF

21 Basic Program Flow F/U CV (1 st ) 2 A~D Model 14 CS (1 st CS ) 4 (2 nd CS ) A~D Model 16 (3rd CS ) HF (1 st HF ) 4 (2 nd HF ) A~D Model 16 (3rd HF )

22 Flow (ITP) (12 ) ) Feedback,, (, ) (fitness)

26 Education

27 Education and Consulting

28 Exercise

29 ITP

30 Participation Participation Participation Participation (%) centage ( ment perc Enrollm

31 Factors influencing a patient s decision Main reasons distance to the CR center patient s belief they could handle their own problems lack of time cost of rehabilitation deficient belief of health providers - Importance of raising i patients t belief they could Eur J Prev Cardiolog Jan 20

32 Factors influencing a patient s decision Asan Medical Center s Experience..??.?....

33 Real Achievement Rate CV A B C FU % 62% 68% CS A B C FU % 50% 100% HF 46 FU 28 61%

35 Case Report M/45 Present illness : 10 1~2 prolonged chest pain 119 cardiac arrest CPCR, STEMI primary PCI at plad with POBA CCU, 1 chest pain CAG POBA site restenosis bare-metal stent t (Jo stent t 2.5X16). 1 stent site POBA. 4 POBA. 10 Risk Factor : DM/HTN/Hyperlipidemia/smoking Risk Factor : DM/HTN/Hyperlipidemia/smoking Obesity (91Kg 173cm)/Sedentary life ( )

36 Case Report

37 Determinating factor DM,HTN,Hyperlipidemia,smokig Poor exercise, OK Type A Multi-vessel ( )

38 Case Report (Outcome) Variables Before After VO2 max (ml/min) Body Weight 91Kg 72.4 Kg HbA1C 9.2% 6.0% T-chol/LDL 235/ /79 BDI 15 2 WHOQOL Symptom + never

39 Summary Inevitable new wave in Korea Really, valuable and necessary action for disease control Individualized Treatment Plan (ITP) Multidisciplinary team approach Shed a light on what we will do for patient Just Do It!!! Needs enormous effort, dedication, and commitment, but in the end, its benefits are well worth the struggle.

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$(Microsoft PowerPoint - S13-3_\261\350\273\363\307\366 [\310\243\310\257 \270\360\265\345])$ Cardiovascular Disease in Metabolic Syndrome 김상현 보라매병원내과 서울대학교의과대학내과학교실 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management