Guidelines for Cardiac Rehabilitation and Secondary Prevention, Fifth Edition, fully embraces the

increasing incidence of coronary heart disease (CHD), the changing demographics of the

patient populations we serve, and the growing importance of the services we provide in the 21st

century. Cardiac rehabilitation and secondary prevention (CR/SP) has evolved substantially

over the past 50 years. The patient population using these program services has progressed from

a predominantly white male population, physically and emotionally debilitated from an acute

myocardial infarction (MI) followed by prolonged bed rest, to an ethnically diverse population of

men and women receiving individualized programs of intensive secondary prevention for CHD

and other cardiac illness or procedures, with or without a precedent hospitalization.1-3 Significant

challenges continue with the underreferral of cardiac patients to CR/SP, particularly women, the

elderly, and the medically underserved.4 In spite of the knowledge that patients referred to CR/

SP are more likely to receive guideline-based care, to improve all lifestyle habits, and to report

improved quality of life and physical and psychological function, referral to CR/SP occurs in less

than 30% of eligible patients.5