Cardiac rehabilitation after acute myocardial infarction: a review of its value and clinical impact

Cardiac rehabilitation (CR) is a structured, multidisciplinary secondary-prevention intervention combining supervised exercise training, risk-factor modification, psychosocial support, and patient education. Decades of trial and registry data establish CR as one of the highest-value interventions available to patients recovering from acute myocardial infarction (AMI), with associations to reduced mortality, fewer reinfarctions, fewer hospital readmissions, improved left ventricular function, and better quality of life. This review synthesizes contemporary evidence on the physiological, clinical, and psychosocial impact of CR after AMI; examines how program timing, intensity, and delivery model (center-based, home-based, hybrid, and digital) shape outcomes; and reviews the substantial gap between guideline recommendations and real-world referral and participation rates. Despite a Class I guideline recommendation and consistent evidence of benefit, fewer than one-third of eligible patients in the United States complete a CR program, with pronounced disparities by sex, race, income, and geography. Closing this implementation gap - through systematic referral, flexible delivery models, and quality-indicator-driven auditing - represents one of the largest remaining opportunities to improve outcomes after AMI.