Each year, an estimated 785 000 Americans will suffer a new myocardial infarction (MI; heart attack), and nearly 470 000 will have a recurrent attack.1 Within 5 years of an initial MI, 15% of men and 22% of women 45 to 64 years of age and 22% of men and women >65 years of age will suffer a recurrent MI or fatal coronary heart disease (CHD).1 Given this high recurrence rate, preventing secondary cardiac events is an essential part of the care for patients with cardiovascular disease (CVD). Cardiac rehabilitation/secondary prevention programs (CR/SPPs) are medically supervised programs that help patients with CVD to recover more quickly after a cardiac event and to stay healthy. CR/SPPs are more than just diet and exercise programs; these programs offer a multifaceted and multidisciplinary approach to optimize the overall physical, mental, and social functioning of people with CVD. CR/SPPs include specific core components that aim to optimize cardiovascular risk reduction, foster healthy behaviors and compliance with these behaviors, reduce disability, and promote an active lifestyle for patients with CVD.2 Comprehensive CR/SPPs consist of baseline patient assessment, nutritional counseling, aggressive risk factor management (ie, lipids, hypertension, weight, diabetes mellitus, and smoking), psychosocial and vocational counseling, and physical activity counseling and exercise training. Patients participating in CR/SPPs are also prescribed cardioprotective drugs that have evidence-based efficacy for secondary prevention. The goal of cardiac rehabilitation and secondary prevention is to stabilize, slow, or even reverse the progression of CVD, which in turn reduces the risk of a future cardiac event. The interventions provided by CR/SPPs are especially important because of the limited time available during the shortened hospital stays and brief outpatient physician visits now common in contemporary medical practice. There is ample evidence on the proven benefits of CR/SPPs on CHD risk factors …

Background—: Although numerous studies have reported that cardiac rehabilitation (CR) is associated with reduced mortality after myocardial infarction, less is known about its association with mortality after percutaneous coronary intervention. Methods and Results—: We performed a retrospective analysis of data from a prospectively collected registry of 2395 consecutive patients who underwent percutaneous coronary intervention in Olmsted County, Minnesota, from 1994 to 2008. The association of CR with all-cause mortality, cardiac mortality, myocardial infarction, or revascularization was assessed with 3 statistical techniques: propensity score–matched analysis (n=1438), propensity score stratification (n=2351), and regression adjustment with propensity score in a 3-month landmark analysis (n=2009). During a median follow-up of 6.3 years, 503 deaths (199 cardiac), 394 myocardial infarctions, and 755 revascularization procedures occurred in the study subjects. Participation in CR, noted in 40% (964 of 2395) of the cohort, was associated with a significant decrease in all-cause mortality by all 3 statistical techniques (hazard ratio, 0.53 to 0.55; P <0.001). A trend toward decreased cardiac mortality was also observed in CR participants; however, no effect was observed for subsequent myocardial infarction or revascularization. The association between CR participation and reduced mortality rates was similar for men and women, for older and younger patients, and for patients undergoing elective or nonelective percutaneous coronary intervention. Conclusions—: We found that CR participation after percutaneous coronary intervention was associated with a significant reduction in mortality rates. These findings add support to published clinical practice guidelines, performance measures, and insurance coverage policies that recommend CR for patients after percutaneous coronary intervention.