Cardiac rehabilitation is centered on prescribing exercise to the patient. But exercise is not all. Cardiac rehabilitation is a comprehensive program that consists of smoking cessation, medication, lifestyle education, diet, and mental therapy. These elements comprehensively provide the most beneficial way to prevent heart disease recurrence by removing harmful lifestyle factors that give rise to heart disease in the first place.

The Korean government began reimbursing cardiac rehabilitation in 2017. Patients can enroll in a heart rehabilitation program within one year of developing heart disease. At a general hospital, cardiac rehabilitation costs about 48,000 won for evaluation, 24,000 won for exercise therapy, and 12,000 won for comprehensive education. Patients can receive 36 exercise sessions per year under insurance.

If a cardiac disease patient participates in cardiac rehab and continues to exercise with the help of a doctor, he or she may improve or eliminate unhealthy lifestyle habits such as smoking, drinking, lack of exercise, and bad eating habits. By eliminating these heart disease risks, cardiac rehabilitation slashes the risk of recurring heart disease and even death.

Many patients experience a vicious cycle of recurring heart disease. Patients with heart disease receive acute hospital care and go home with prescriptions. However, patients often suffer a second heart disease because they return to their old lifestyle habits, which may include smoking and drinking, among others, and do not comply with medication instructions. This vicious cycle not only worsens prognosis but also adversely affects socio-economic healthcare costs as a whole. Cardiac rehabilitation is therefore crucial in Korea, considering it is a rapidly aging country where the incidence of heart disease is rising.

"Heart rehabilitation not only improves patient prognosis but is cost-effective. It is also similar or superior to other medical interventions," said Professor Peter Brubaker, a specialist in cardiac rehabilitation at the University of Wake Forest University, at a domestic conference in October.

Various research has shown that cardiac rehabilitation has numerous health benefits. It is also cost-effective for both the individual and the economy as a whole.

According to research done by the Mayo Clinic, correcting lifestyle habits with cardiac rehabilitation reduces the risk of re-admission from all causes by about 25 percent. Many studies have also shown that cardiac rehabilitation lowers the risk of all-cause death by 30 to 50 percent.

A research team at the University of Linkoping in Sweden found that if myocardial infarction patients participate in cardiac rehabilitation after coronary artery bypass grafting, their hospitalization period would be cut from 16 to 11 days, reducing medical costs per patient by approximately $12,000.

The Finnish Turk University research team additionally found that 56 percent of patients who participated in cardiac rehabilitation after coronary artery bypass surgery were able to return to work while only 38 percent of those who received general treatment after coronary artery bypass surgery did.

Although evidence for the clinical benefits of cardiac rehabilitation is accumulating around the world, experts point out that it remains underutilized in Korea.

The most significant barriers to cardiac rehabilitation are the lack of referrals between physicians, the lack of motivation from patients, and the lack of appropriate insurance coverage. These problems stem from the patients', doctors', and the government's general lack of information and awareness.

An alternative to some of the problems with hospital-based cardiac rehabilitation is 'home-based' cardiac rehabilitation.

Unlike hospital-based cardiac rehabilitation, home-based cardiac rehabilitation can increase the rate of success by eliminating the need for frequent visits to the hospital by conducting cardiac rehabilitation at home or a nearby gym.

However, home-based cardiac rehabilitation, although proven effective, is not utilized in Korea since remote monitoring is illegal. Experts, therefore, believe Korea is lagging in revitalizing heart rehabilitation compared to the US and abroad.

Domestic experts are calling for an increased cardiac rehabilitation participation rate in a rapidly aging society.

According to many experts, it is vital to increase the referral rate between doctors, making cardiac rehabilitation an essential "prescription." Medical staff must also educate patients for them to participate in cardiac rehabilitation. Finally, the government should recognize the importance of cardiac rehabilitation and set a reasonable reimbursement price.

Four medical associations have also banded together to standardize cardiac rehabilitation in the country. In June, the Korean Academy of Rehabilitation Medicine, the Korean Academy of Cardio-Pulmonary Rehabilitation, the Korean Society of Cardiology, and the Korean Society of Thoracic and Cardiovascular Surgery published the country's first cardiac rehabilitation guidelines.

"The main purpose of the guidelines is to assure cardiac patients that cardiac rehabilitation is necessary," said Profesor Kim Chul from Inje University Sanggye Paik Hospital, who was in charge of the guideline publication. "The guidelines, therefore, aim to activate the utilization of cardiac rehabilitation in the country both by patients and doctors."