Cardiovascular diseases (CVDs) remain the leading cause of death globally, accounting for approximately 20.5 million deaths annually, with a disproportionate burden in low- and middle-income countries. As the prevalence of CVD continues to increase, cardiac rehabilitation (CR) has emerged as a cornerstone of secondary prevention and long-term management. This narrative review examines the historical evolution, current practices, and future directions of CR, with particular emphasis on patients undergoing cardiac surgery – a population with unique recovery challenges and increased vulnerability. Global case studies illustrate the diversity of CR systems, and emerging trends such as telehealth, artificial intelligence, and culturally adapted care are discussed as tools to expand access and personalize care. Barriers to CR implementation – including socioeconomic inequities, referral gaps, and policy limitations – are analyzed, alongside proposed solutions supported by implementation science frameworks. The review concludes that expanding and modernizing CR programs is both a clinical imperative and a global health priority.