This report has been prepared by the Japanese Association of Cardiac Rehabilitation (JACR):
Professor Shigeru Makita, President of JACR
MD, PhD, Professor, Physiatrist, President of JACR
Department of Cardiac Rehabilitation
Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
Professor Shinji Koba, Director of JACR
MD, PhD, Professor, Cardiologist, Director of JACR
Department of Medicine, Division of Cardiology, Showa University School of Medicine
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Health care
In Japan, a universal health insurance system was created in 1961. This system includes the following:
- All people are obligated to have one of the public healthcare insurance schemes
- Which public healthcare insurance scheme is expected to have depends on his/her occupation, age and resident area
- People are allowed to freely choose their medical institutions and the frequency of visitation at their own discretion regardless of the type of their insurance scheme (free access system).
Average life expectancy in 2019 was 81 years in males and 87 years in females, the world-leading longevity since 1980s. The elderly population over 65 years was 29% in 2019.
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Risk factors
The mean systolic blood pressure has been substantially decreasing for both men and women in Japan. Additionally, the smoking rate for men exceeding 70% in the 1960s has been decreasing gradually.
In contrast, the prevalence ratio of hypercholesterolaemia in our country has had a tendency to increase in recent years, particularly noticeable among middle-aged and older men.
In the meantime, the prevalence ratio of diabetes has tended to increase in these years for both men and women and the ratio of obesity has been increasing among men. Changes of dietary style with Westernisation and physical inactivity were associated with increased cardiometabolic risk, especially younger and middle-aged population.
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Main actors and prevention methods
The number of doctors and dentists has been increasing year after year, reaching 277,927 for doctors and 97,198 for dentists respectively in 2006. There are 1,333,000 nurses in Japan. The number of cardiologists is 14,529 (11.5 per 100,000 inhabitants, 2018) while that of cardiovascular surgeons is 2,279 (2020). Japan has 1,019 cardiology training hospitals authorised by the Japanese Circulation Society (JCS), and 322 training-related ones. Besides these training facilities, cardiologists and cardiovascular surgeons work at a general hospital or practice in their own clinic.
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Prevention activities
The government of Japan launched a health promotion plan named “Health Japan 21” in 2000, and its secondary version in 2013. This initiative aims to raise the rates of medical check-ups and health guidance for the purpose of preventing the incidence and aggravation of cancers, cardiac diseases, cerebrovascular diseases and lifestyle-related diseases including diabetes attributable to the changes in its people’s lifestyle habits and the rapidly advancing aging of its population.
In December 2018, the “Basic Act on Stroke and Cardiovascular Diseases” was enacted. The purpose of this act is to extend the healthy life expectancy of people and consequently alleviate the burdens of medical/nursing care costs by promoting the prevention of circulatory diseases such as strokes and myocardial infarction (MI) and by preparing agile and appropriate medical treatment systems for such diseases.
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Cardiac rehabilitation
There are 1,337 hospital providing inpatient cardiac rehabilitation (CR) programmes, while 531 hospitals and clinics provide outpatient CR programmes. Although we do not have a nationwide survey for the exact participation rate of CR programmes, about four to eight percent of patients with acute MI (AMI) (1) and seven percent of patients with heart failure participated in an outpatient CR programme (2).
The typical outpatient CR programme starts approximately 2–3 weeks after AMI or undergoing cardiovascular surgery such as coronary artery bypass graft surgery (CABG) and continues for 3–5 months. The programme includes hospital-based supervised exercise sessions (1–3 times weekly, consisting of walking, bicycling with an ergometer, and calisthenics), educational classes and individual counselling, combined with a home exercise programme. The exercise intensity is determined individually at 50–60% of the heart rate reserve, or the heart rate at the anaerobic threshold level obtained by cardiopulmonary exercise testing using a cycle ergometer.
The home exercise programme consists mainly of brisk walking at a prescribed heart rate for 30–60 min, 2–4 times each week. CR is covered by the public health insurance system for AMI, angina pectoris, heart failure, peripheral artery disease, great artery disease and cardiovascular surgery.
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Aims for the future
The present and future medical service provision system in Japan mainly deals with chronic heart failure and accordingly its treatments are not completed inside an acute care hospital. Japanese people need to do exercises through CR, receive nutrition intervention and manage their cardiac disease from the acute phase to the chronic phase (maintenance phase) in order to prevent rehospitalisation and re-aggravation.
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Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
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