We refer to the article by Vasco et al. recently published in the Journal about the experience of a single cardiac rehabilitation (CR) center, concerning cardiovascular (CV) risk control in post-myocardial infarction (MI) patients enrolled in a phase II CR program.1

In their article, the authors state their difficulty in controlling CV risk factors in post-MI patients, reporting that at the end of the phase II CR program only 17% had achieved the low-density lipoprotein cholesterol (LDL-C) targets recommended in the European Society of Cardiology (ESC) guidelines, namely LDL-C less than 55 mg/dl and an at least 50% decrease from the baseline level.2 The authors also declare that only 28% of the enrolled patients achieved either of the mentioned targets.1

In this letter, we report on the experience of the Leiria Hospital Center CR unit, highlighting that in the analysis of our first patient series in which 68 patients had finished the phase II program, 66% achieved both ESC guideline LDL-C targets and 82% achieved one or other of the two targets.

Regarding glycated hemoglobin (HbA1C) levels, Vasco et al. state that in the 26% of the patients in their analyzed population who were diabetic, 51% achieved an HbA1C value lower than 6.5%.

In our CR unit, regarding the same analysis, we found an equal percentage of diabetic patients but 90% of them achieved an HbA1C value of less than 6.5% by the end of the program.

Our study sample included 93 patients, with a mean baseline LDL-C of 119.4 mg/dl, 68 of whom had a mean LDL-C value of 61.7 mg/dl at the end of the phase II program.

The article by Vasco et al. does not permit a detailed analysis of the rehabilitation program that serves the population under discussion, but as the authors effectively admit, their results are not as expected and are much less than desired.

In our series, with clearly better results, the rehabilitation program has a strong motivational, relaxation and teaching component, achieved in group classes and specialized sessions, particularly concerning psychology.

An additional factor that may help to explain our better results is the use in a large subset of patients of a telemonitoring program, which aims for closer monitoring of patients through a special smartphone app.3,4

By requesting the publication of this letter, we only intend to show that despite all known difficulties and barriers, an effective cardiac rehabilitation program with a strong educational and motivational component may lead to better results. Recognition of these better results will stimulate the team as well as motivate patients to achieve the recommended goals, which will truly modify the natural history of the disease.5,6