Barriers of Cardiac Rehabilitation after Myocardial Infarction in India: A Narrative Review

Cardiac rehabilitation (CR) is a structured, multidisciplinary approach proven to enhance recovery, improve functional outcomes, and reduce recurrence risk after myocardial infarction (MI). In India, CR participation remains minimal, hindered by a combination of patient, provider, and health system barriers. Common patient-level challenges include limited awareness, competing personal or cultural priorities, financial hardship, and difficulty accessing facilities. Provider-related barriers involve inconsistent referral practices, inadequate training in CR principles, and lack of standardized implementation frameworks. At the system level, the scarcity of CR centers, concentration of services in urban areas, insufficient workforce capacity, and absence of national policy directives limit program availability. Addressing these challenges calls for integrated strategies such as embedding CR into routine cardiac care pathways, expanding insurance and government coverage, enhancing provider education, and developing cost-effective home-based and tele-rehabilitation models suitable for diverse Indian populations. Implementing such measures could substantially increase CR uptake, ultimately reducing post-MI morbidity and mortality in the country.