This study evaluates the impact of a cardiac rehabilitation program (HeartSmart) in a rural area on the quality of life, dietary behaviour, weight loss and physical activity participation of patients with cardiovascular disease (CVD) or at high risk of CVD.The evaluation of the program consisted of a single group pre and post-test design with follow-up at 3, 6 and 12 months after program completion, complemented with a cross-sectional survey of non-participants as a pseudo comparison group.The HeartSmart program is a hospital-based cardiac rehabilitation program in Bunbury, a regional centre of Western Australia.A total of 203 participants and 159 non-participants.The program consisted of 7 weeks of education and exercise sessions.The program had a high rate of completion (92%). Evaluation results suggested that HeartSmart participants demonstrated significant improvements in quality of life, compliance with medication, dietary behaviour, weight loss and physical activity participation. The largest changes were mostly observed between pre and post-program stages, with sustained behaviour change at 6 months after the completion of the program. Further evidence of the HeartSmart benefits was provided through significantly better health-related behaviour, confidence to diet and exercise, dietary fat intake, cardiac knowledge and quality of life scores among HeartSmart participants compared with non-participants.While this program has achieved its objectives, there are a few issues that need to be considered by similar programs: the post-program stage of patient follow-up by general practitioners; the geographical disadvantage of those living outside regional centres to access the service; enhancing the primary prevention aspect of the program; adapting the program to the needs of Aboriginal clients; facilitating evaluations by resourcing and training program staff in computer skills. WHAT IS ALREADY KNOWN ON THIS SUBJECT: The viability of establishing cardiac rehabilitation programs in rural Australia has been questioned and few if any have been formally evaluated, particularly using a follow-up design and a control group.This study ascertains the benefits of secondary prevention programs in rural areas not only on the quality of life but also shows positive outcomes in lifestyle modification for program participants compared to non-participants. The lessons learnt can improve the effectiveness of similar prevention programs.