Regional disparities in cardiac rehabilitation volume throughout Japan based on open data from a National Database of Health Insurance Claims.

Objective: This study assessed the regional disparities and the associated factors in the implementation of cardiac rehabilitation in Japan. Materials and Methods: Regional disparities were investigated by comparing the number of cardiac rehabilitation units in each of 47 prefectures in Japan based on the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labour, and Welfare. The relationships between the numbers of inpatient and outpatient cardiac rehabilitation units and the numbers of registered instructors of cardiac rehabilitation, board-certified physiatrists, and board-certified cardiologists were examined. Results: The region with the highest and lowest numbers of inpatient units showed 11,620.5 and 1,650.2 population-adjusted cardiac rehabilitation units adjusted per 100,000 population, respectively, corresponding to a 7.0-fold difference. Meanwhile, 4,865.3 and 238.6 units were present in the regions with the highest and lowest numbers of outpatient units, respectively, corresponding to a 20.4-fold regional disparity. Our analysis showed that the population-adjusted number of inpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.647, P<0.001) and board-certified cardiologists (r=0.445, P=0.002) but only marginally associated with the population-adjusted number of board-certified physiatrists (r=0.329, P=0.024). Moreover, the population-adjusted number of outpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.406, P=0.005) and board-certified cardiologists (r=0.450, P=0.002) but not with the population-adjusted number of board-certified physiatrists (r=0.078, P=0.603). Conclusion: Large regional disparities were observed during the implementation of cardiac rehabilitation. Increased numbers of cardiac rehabilitation instructors and cardiac rehabilitation practices are expected to eliminate these regional differences in cardiac rehabilitation practices.

Comparison of haemodynamic response to muscle reflex in heart failure with reduced vs. preserved ejection fraction.

AIMS: Isometric handgrip (IHG) training reduces the blood pressure in patients with hypertension. It is unclear how IHG exercise affects the haemodynamics and cardiovascular function through the muscle reflex in patients with heart failure (HF) with reduced (HFrEF) and preserved ejection fraction (HFpEF). METHODS AND RESULTS: Twenty patients (HFrEF: n = 10, HFpEF: n = 10) underwent left ventricular (LV) pressure-volume assessments using a conductance catheter and microtip manometer to evaluate haemodynamics, LV and arterial function, and LV-arterial coupling during 3 min of IHG at 30% of maximal voluntary contraction (MVC), followed by 3 min of post-exercise circulatory arrest (PECA). Three minutes of IHG exercise produced significant and modest increases in the heart rate (HR) and LV end-systolic pressure (LVESP), respectively, in both HFpEF and HFrEF groups. In HFrEF, the increase in LVESP was caused by the variable increase in effective arterial elastance (Ea), which was counterbalanced by the increase in LV end-systolic elastance (Ees), resulting in a maintained Ees/Ea. In HFpEF, the increase in LVESP was not accompanied by changes in Ea, Ees, Ees/Ea, or LV end-diastolic pressure. LVESP during PECA was not maintained in HFpEF, suggesting smaller metabo-reflex activity in HFpEF. CONCLUSIONS: The IHG exercise used in this study may increase the LVESP and LVEDP without detrimental effects on cardiac function or ventricular-arterial coupling, especially in HFpEF patients. The effects of IHG exercise on haemodynamics and ventricular-arterial coupling may be affected by the patient background and the type and intensity of the exercise.