Potential Clinical, Behavioral, and Healthcare-System Pathways Linking Early Cardiac Rehabilitation to 30-Day Readmission After Myocardial Infarction

Cardiac rehabilitation is recommended after myocardial infarction, but its relationship with readmission during the first 30 days after discharge remains uncertain. This narrative review examines potential clinical, behavioral, and healthcare-system pathways linking early rehabilitation to this outcome. Guidelines, evidence syntheses, cohort studies, referral interventions, and telehealth research inform the discussion. Rehabilitation may support early stability through clinical monitoring, medication review, symptom education, graded activity, risk-factor management, and psychosocial care. However, studies use inconsistent definitions of referral, enrollment, attendance, and early initiation; many include mixed cardiac populations or assess outcomes beyond 30 days. No included publication directly evaluates clearly timed early rehabilitation initiation against exactly 30-day post-discharge readmission in a myocardial-infarction-only population. The proposed pathways therefore derive from indirect evidence. Access barriers and program capacity may interrupt treatment exposure, while home-based and hybrid delivery offer potential alternatives with their own limitations. The proposed Early Cardiac Rehabilitation Continuity Framework integrates access and treatment stages as an evidence-informed hypothesis rather than a validated causal model. Prospective studies should standardize exposure definitions, establish temporal ordering, account for selection into rehabilitation, and distinguish all-cause from cardiovascular readmission. Cardiac rehabilitation has broader secondary-prevention benefits, but an independent effect of early initiation on 30-day readmission remains unestablished.