Cardiac rehabilitation as a first step in the secondary prevention of coronary heart disease

Despite that coronary heart disease is still the major cause of death in th e industrialized countries and in some with emerging economies, a steady de cline in the mortality for coronary heart disease has been observed in the last 30 years. This has been attributed predominantly to a reduction in smo king and in the cholesterol blood levels, two of the major risks factors fo r coronary heart disease. Cardiac rehabilitation programs represent today o ne of the most cost effective interventions to reduce the morbidity and mor tality after a coronary event. They offer a unique opportunity to guide a p atient immediately after an acute coronary episode through the inpatient ca re to the outpatient environment. In these programs a strong emphasis is ma de in the educational aspects of secondary prevention of coronary heart dis ease as well as in motivating patients to achieve life long lasting behavio ral changes impacting on the major risk factors (smoking cessation, regular exercise, weight control, etc). The current subutilization of the Cardiac Rehabilitation Programs appears to be related to a variety of factors that include, among others, financial restraints and cultural values and percept ions with reference to health care.