A meta-analysis of cohort studies in patients after acute MI showed that smoking cessa- tion reduced the subsequent cardiovascular mortality rate by ranking it among the most powerful secondary The SAVE (Sleep Apnea Cardiovas- cular Endpoints) study investigators reported that in selected patients with LV systolic dysfunction after MI, smoking ces- sation, compared with continued smoking, is associated with a 40% lower hazard of all-cause mortality and a 30% lower hazard of death, recurrent MI, or HF hospitalization.605 Reasonable evidence from RCTs indicates that counseling hospitalized smokers after acute MI increases smoking cessa- tion rates, provided that the initial contact during the hospital stay is followed by repeated contacts, usually by telephone, for 3 months after discharge.603,604 Similarly, the odds of smoking cessation are greater among patients who receive discharge recommendations for cardiac rehabilitation.604 Patients with depressive symptoms during the MI hospitaliza- tion and early convalescence are less likely to quit smoking and may require more intensive treatment to achieve cessa- Counseling should be provided to the patient and family, along with pharmacological therapy as deemed safe, and access to formal smoking-cessation programs should be facilitated. 11.1.3. Cardiac Rehabilitation The objectives of contemporary exercise-based cardiac reha- bilitation are to increase functional capacity, decrease or alle- viate anginal symptoms, reduce disability, improve quality of life, modify coronary risk factors, and reduce morbidity and mortality rates.598,613,614 Core components include patient assessment; ongoing medical surveillance; nutritional coun- seling; BP, lipid, and diabetes mellitus management; smoking cessation; psychosocial counseling; physical activity coun- seling; exercise training; and pharmacological treatment, as Among 601099 US Medicare beneficiaries who were hospitalized for coronary conditions or revascularization procedures, mortality rates were 21% to 34% lower among participants in cardiac rehabilitation programs than among It has been suggested that contemporary reperfusion and cardioprotective drug therapies may dimin- ish the impact of adjunctive exercise-based cardiac reha- bilitation programs on post-MI survival rate. 