Secondary prevention after acute coronary syndromes is the key strategy to reduce the residual cardiovascular disease risk. A tailored assessment is necessary to suggest the best management and treatment for patients. Sex and gender differences should be strongly considered during cardiovascular evaluation and risk estimation. Indeed, women have a worse outcome than men and are less likely to receive appropriate treatment and evidence-based management. Proper lifestyle management, guideline-directed medical therapy, risk factor management, and cardiac rehabilitation should be recommended early after an acute event in women to reduce the high risk of recurrent events and mortality and improve quality of life. Women-focused cardiac rehabilitation and secondary prevention represent a necessary step in the management and treatment of patients to ensure the best evidence-based care after acute coronary syndromes. This review offers a critical, updated, and comprehensive overview of the appropriate strategies for secondary prevention in women after acute coronary syndromes and long-term treatment, with a focus on cardiac rehabilitation programs. Furthermore, gaps in evidence on this topic and practical recommendations will be provided.

Cardiac rehabilitation is strongly recommended in secondary cardiovascular prevention. In patients after coronary artery bypass grafting, this intervention is suggested to reduce mortality, morbidity, and disability. In addition, rehabilitation programs improve quality of life and cardiorespiratory fitness. Modern cardiac rehabilitation programs include structured exercise training, education, nutritional counseling, psychosocial support, and management of cardiovascular risk factors, each tailored to the specific needs of post-coronary artery bypass grafting patients who often face a high burden of comorbidities and surgical recovery challenges. For these reasons, cardiac rehabilitation should be regarded as standard of care. Evidence supports early cardiac rehabilitation initiation and individualized multidisciplinary plans, which have shown to improve exercise capacity, health-related quality of life, and medication adherence. Long-term follow-up is essential, as studies have demonstrated a clear association between sustained cardiac rehabilitation engagement and decreased rates of rehospitalization and all-cause mortality. Therefore, this comprehensive review presents recent advances and updates on the management of patients after coronary artery bypass grafting during cardiac rehabilitation, with a focus on the core components and long-term follow-up.