Outpatients' cardiac rehabilitation: the long-term experience of the Niguarda Hospital.

Background: Cardiac rehabilitation (CR) is a cornerstone of secondary prevention, yet long-term real-world data on outpatient programs remain limited. We report the long-term experience of a high-volume centre, evaluating clinical profiles, temporal trends, and functional and metabolic outcomes of patients undergoing outpatient CR. Methods: We analysed 1461 consecutive patients enrolled in the Niguarda Hospital outpatient CR program from 2012 to 2025. Demographic, clinical, angiographic, biochemical, hemodynamic, functional, and pharmacological data were collected at admission and discharge. Results: Acute coronary syndrome was the leading indication (70.8%), though its prevalence declined over time, paralleled by a progressive rise in chronic coronary syndrome and non-ischemic indications. Patients became older and more comorbid, yet consistently achieved significant improvements in functional capacity (Δ6MWT +28.4 ± 24.4%, p < 0.001), left ventricular ejection fraction (from 53.3 to 55.2%, p < 0.001), and lipid profile (LDL cholesterol from 99.6 ± 42.0 to 64.8 ± 26.2 mg/dL, p < 0.001). Rates of complete revascularization increased markedly, smoking patterns shifted toward cessation, and uptake of advanced cardioprotective therapies rose substantially. Despite reduced volumes and higher baseline complexity during COVID-19 (2020-21), CR effectiveness was preserved. Conclusions: Over 13 years, outpatient CR consistently delivered robust functional and metabolic benefits, even in an increasingly older and more complex population. Shifts in patient characteristics, improved revascularization rates, and evolution of pharmacological therapy underscore the expanding role of CR as a comprehensive, guideline-driven component of modern cardiovascular care.