Cardiac Rehabilitation Adherence and Long-Term Outcomes Post Myocardial Infarction: A Mixed-Methods Study of Patient Motivation, Barriers, and Program Satisfaction

Background Participation in a cardiac rehabilitation (CR) program is a key component of secondary prevention following myocardial infarction (MI). However, adherence to CR varies considerably and may influence functional recovery and short-term clinical outcomes. Understanding the factors that facilitate or hinder participation may help optimize rehabilitation programs and improve patient outcomes. This prospective mixed-methods study assessed the association between adherence to CR and clinical outcomes four months after MI and explored the motivational factors, perceived barriers, and patient experiences influencing adherence. Materials and methods A prospective mixed-methods study was conducted among 150 post-MI patients who were followed for four months after enrolment. Participants were categorized according to CR adherence as high (>80% attendance; n = 87, 58%), moderate (50%-79%; n = 36, 24%), or low (<50%; n = 27, 18%). Quantitative outcomes included functional capacity assessed using the six-minute walk test (6MWT), medication adherence, recurrent myocardial infarction, and rehospitalization. Qualitative data were obtained through semi-structured interviews exploring perceived health benefits, barriers, motivators, and patient satisfaction. Quantitative data were analyzed using comparative statistical methods, while qualitative interviews underwent thematic content analysis. Results High adherence to CR was associated with significantly greater improvement in functional capacity (mean increase: 120 ± 25 m) compared with the moderate-adherence (65 ± 20 m) and low-adherence (30 ± 15 m) groups (p < 0.001). Recurrent myocardial infarction during the four-month follow-up occurred in 6% of participants in the high-adherence group compared with 19% and 30% in the moderate- and low-adherence groups, respectively (p < 0.05). Rehospitalization rates were also lower among participants with high adherence (10%) than among those with moderate (22%) or low adherence (37%) (p < 0.05). Qualitative analysis identified perceived health benefits, family support, and positive interactions with healthcare professionals as important facilitators of adherence, whereas financial constraints, occupational commitments, greater travel distance, transportation-related difficulties, and limited awareness of CR were the principal barriers. Higher satisfaction with the rehabilitation program was observed among participants with high adherence. Conclusion Higher adherence to CR was associated with improved short-term functional recovery and lower rates of recurrent myocardial infarction and rehospitalization during the four-month follow-up period. The mixed-methods findings indicate that both personal and health system factors influence adherence. Strategies that improve patient education, accessibility, family support, and patient-centered delivery of CR programs may help enhance adherence and optimize recovery following MI.