Background: Cardiac rehabilitation (CR) is a fundamental pillar in the therapeutic pathway of patients with cardiovascular disease, contributing significantly to improving quality of life and reducing the risk of cardiovascular event recurrence. Over the past decades, this approach has progressively evolved, integrating multidisciplinary strategies based on scientific evidence. This study aimed to conduct a detailed analysis of the anthropometric, clinical, and functional characteristics of patients enrolled in the CR Unit of the San Giovanni di Dio and Ruggi D’Aragona University Hospital in Salerno, with particular attention to therapeutic changes, drug titration, and cognitive assessment. Methods: Specifically, the anthropometric, clinical, laboratory, and instrumental data of 95 patients (age 66.56 ± 0.99 years, 75% male) who underwent the CR program between 2023 and 2025 were analyzed. Results: Patients with various diagnoses were enrolled in the CR program: 17% heart failure, 18% cardiac surgery, 20% acute coronary syndrome, 16% chronic coronary syndrome, 29% dyspnea. The patients had numerous comorbidities and risk factors: 73% arterial hypertension, 77% dyslipidemia, 35% diabetes mellitus, 33% smoking, 13% thyroid dysfunction, 47% CAD, 18% CKD, 16% COPD. At baseline, Cardiopulmonary exercise test (CPET) showed a moderately reduced functional capacity (VO₂ peak pre-CR: 14.29 ± 0.53 mL/min/kg; VO₂% predicted pre-CR: 62.19 ± 2.43%), and a significant improvement was recorded in meters at 6 min walk test (6MWT) post-CR (pre-CR: 306.02 ± 9.93 m vs. post-CR: 378.88 ± 13.37 m; p < 0.05). Notably, 22% of patients had a Qmci score < 49.4 points, indicating an MCI. Finally, the cardiovascular therapy was titrated and adapted; specifically, we recorded a significant increase in the use of SGLT2i therapy (pre-RC 22.00% vs. post-RC 34.00%; p < 0.05). Conclusions: In conclusion, CR proved to be safe and effective in enrolled patients; further studies will be needed to investigate the therapeutic modifications implemented during CR programs in more detail.

Cardiac rehabilitation (CR) is strongly recommended in secondary cardiovascular prevention; indeed, in patients after cardiac surgery or with coronary artery disease or heart failure, this intervention is recommended to decrease mortality, morbidity, and disability, and to improve quality of life and cardiorespiratory fitness. Moreover, each step of the cardiovascular continuum denotes a potential risk factor for the progression of cognitive frailty; this interaction is highly prevalent, affecting approximately one-third of all patients in cardiology settings. For these reasons, CR should consider the patient’s cognitive domain; however, cognitive assessment is still rarely integrated into standard CR protocols. Therefore, this comprehensive review presents current evidence and recent updates on the interaction between CR and cognitive impairment, focusing on physiological mechanisms, core components, benefits, and strategies for implementing CR in patients with cognitive frailty to optimize recovery and prognosis.