[Cardiac rehabilitation: a plus value for secondary prevention?]

In patients with a history of myocardial infarction, cardiovascular mortality in the absence of treatment is high (5% per year after a first myocardial infarction and 10% per year after a subsequent myocardial infarction). There is a convincing evidence that secondary prevention reduces the risk of new ischemic events and mortality. Specifically, the modification of cardiovascular risk factors and the use of prophylactic treatments have shown that the risk of a further major ischemic event abruptly decreases. There are a number of effective therapies to consider for these patients after myocardial infarction. Careful patient assessment and individualized treatments are required for the maximum benefit. Patients with coronary artery disease can benefit from both medical and life-style secondary prevention measures. Nevertheless half of these patients in general practice does not have the opportunity for an effective medical intervention. Thus, there appears to be a considerable gap between the ideal management and the actual management in practice of these patients. Several types of strategies to improve disease management may be ineffective. Rehabilitation Centers can assure a continuum in the standard care for patients with coronary artery disease and thus they represent a plus value in secondary prevention.