The COVID-19 outbreak is having a significant impact on both cardiac rehabilitation (CR) inpatient and outpatient healthcare organization. The variety of clinical and care scenarios we are observing in Italy depends on the region, the organization of local services and the hospital involved. Some hospital wards have been closed to make room to dedicated beds or to quarantine the exposed health personnel. In other cases, CR units have been converted or transformed into COVID-19 units [1]. While the epidemic curve has shown exponential growth that is flattening only now, the incidence of hospitalizations of cardiac patients in the acute phase has under- gone an inverse trend. A widespread reduction in the access of car- diac patients with heart attack or acute heart failure in the emer- gency room has been observed throughout Italy, causing the partial or total “paradox” of empty CCUs and cardiology units. Many patients with acute myocardial infarction had possibly underesti- mated their symptoms and did not go to hospital for fear of conta- gion and had a late access to treatment and interventions. This still