Cardiac rehabilitation with exercise was initially recommended to improve patients’ functional capacity and relieve residual angina following acute myocardial infarction (AMI). It subsequently evolved into comprehensive cardiac rehabilitation by incorporating secondary prevention strategies (eg, nutritional, lifestyle, psychosocial, and smoking cessation counseling; risk factor management; and education about medications and compliance).¹ Nowadays, referral to comprehensive cardiac rehabilitation is a mainstay management strategy after AMI.¹

The article by Kureshi et al² in this issue of JAMA Cardiology examined the association of cardiac rehabilitation with patient-reported health status outcomes after AMI. Their observational analysis included 4929 patients from the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status and Prospective Registry Evaluating Myocardial Infarction: Events and Recovery registries who had baseline and 6 to 12 months of follow-up health status data and information regarding cardiac rehabilitation participation. Patients who participated in at least 1 cardiac rehabilitation session and nonparticipants experienced improvements in health status outcomes (Seattle Angina Questionnaire domain scores and the Medical Outcomes Study 12-Item Short-Form Health Study summary scores) over a 12-month period after discharge. However, the investigators found no clinical differences in the mean Seattle Angina Questionnaire domain and 12-Item Short-Form Health Study summary scores between propensity-matched cardiac rehabilitation participants and nonparticipants. To assess referral, survivor, and loss to follow-up bias, they conducted sensitivity analyses and demonstrated findings concordant to those of the overall study population. Notably, they showed that participation in cardiac rehabilitation was associated with a 41% lower hazard of all-cause mortality up to 7 years of follow-up.²