Secondary prevention and cardiac rehabilitation in patients with chronic coronary syndromes: long-term management and treatment

Patients with chronic coronary syndromes deserve high attention and tailored management for the effective reduction of the residual cardiovascular risk. Long-term secondary prevention strategies are the key to reaching this goal and mitigating the overall cardiovascular burden. Four pillars should be the cornerstones of the management of patients with chronic coronary syndromes: lifestyle interventions, cardiac rehabilitation, risk factor control and achievement of treatment targets, and guideline-directed medical therapy. These interventions should be personalized to achieve prevention and treatment goals in order to improve prognosis and health-related quality of life. Herein, we present a state-of-the-art review on the comprehensive cardiovascular risk assessment and secondary prevention among patients with chronic coronary syndromes. In addition, we provide practical guidance for the management of this patient population in complex clinical scenarios and specific groups, including those with heart failure, older adults, sex-specific considerations, high bleeding risk, atrial fibrillation, and chronic kidney disease.