Phase II Cardiac Rehabilitation Under Compulsory Insurance in Kazakhstan: A Five-Year Cohort Analysis of Clinical and Economic Outcomes
Sergeyeva Y. Yermukhanova L.S. Nurbakyt A.N. Kurmanalina G.L. Walkowiak D. Nogayeva M.G. Afshar A.
September 2025Multidisciplinary Digital Publishing Institute (MDPI)
Journal of Clinical Medicine
2025#14Issue 17
Background/Aim of Study: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality globally. Cardiac rehabilitation (CR) plays a pivotal role in the recovery of post-acute myocardial infarction (AMI) patients. Despite evidence supporting its clinical benefits, CR remains underutilized, especially in middle-income countries like Kazakhstan. This study aimed to evaluate the clinical effectiveness and economic impact of phase II CR among patients with AMI treated at the Almaty City Cardiology Center between 2018 and 2022. Methods: A retrospective cohort study was conducted using data from 2672 AMI patients. Two cohorts were compared: those who participated in phase II CR and those who did not. Primary outcomes included changes in left ventricular ejection fraction (LVEF), rehospitalization rates, and return to active work. Results: Economic outcomes involved direct medical costs related to initial hospitalization and follow-up care. CR participants showed significant improvements in LVEF (53.7% vs. 49.0% in non-CR patients, p < 0.001). Despite these clinical benefits, there was no significant reduction in long-term treatment costs between the CR and non-CR groups. CR users had slightly higher initial treatment costs but similar cumulative costs for subsequent treatments over two years. Importantly, government funding limitations were found to hinder the full effectiveness of CR programs in Kazakhstan. Conclusions: Phase II CR improves cardiac function in AMI patients but does not reduce long-term treatment costs. The current insufficient government funding for CR limits its broader impact. Expanding CR services and increasing funding are essential to maximize its benefits within Kazakhstan’s healthcare system.
acute myocardial infarction , cardiac rehabilitation , health economics , Kazakhstan , left ventricular ejection fraction
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Department of Public Health and Public Health Care, West-Kazakhstan Marat Ospanov Medical University, Aktobe, 030019, Kazakhstan
Department of Public Health, Asfendiyarov Kazakh National Medical University, Almaty, 050012, Kazakhstan
Department of Internal Medicine No. 2, West-Kazakhstan Marat Ospanov Medical University, Aktobe, 030019, Kazakhstan
Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznan, 61-701, Poland
Department of Rheumatology, Asfendiyarov Kazakh National Medical University, Almaty, 050067, Kazakhstan
Department of Public Health and Public Health Care
Department of Public Health
Department of Internal Medicine No. 2
Department of Organization and Management in Health Care
Department of Rheumatology
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