Introduction <p>Myocardial infarction in the elderly can impact their self-efficacy. Spiritual health is considered a key factor in promoting self-efficacy. But the role of mediating variables such as resilience in this relationship remains ambiguous. Therefore, the present study was conducted to determine the mediating role of resilience in the relationship between spiritual health and self-efficacy in the elderly with myocardial infarction.</p> Methods <p>This cross-sectional descriptive study was conducted among 150 elderly people with myocardial infarction referred to medical training centers in Qazvin, Iran in 2023-2024. Sampling was done by convenience methods. Data were collected through a demographic characteristics checklist, the Connor–Davidson Resilience Scale, the Politzin–Ellison Spiritual Health Questionnaire, and the Sullivan Self-Efficacy Questionnaire. Descriptive statistics such as mean, standard deviation, number, and percentage were used to describe the data. Structural equation modeling (SEM) was used to determine the mediating role of resilience in the relationship between the two variables of spiritual health and self-efficacy.Data analysis was done using SPSS22 and Mplus version 7.3 software.</p> Results <p>The mean age of patients was 70.71±6.68. Patient’s mean scores in the resilience variable were 49.39±18.83, self-efficacy 30.92±13.49, and spiritual health 68.75±7.49. The results showed a significant relationship between spiritual health and resilience (<i>P</i>=0.001) and self-efficacy (<i>P</i>=0.004) and between resilience and self-efficacy (<i>P</i>&lt;0.001). The results showed that there is a significant relationship between self-efficacy and spiritual health both directly (β=0.16) and indirectly (β=0.37). According to the results, 60% of the variance of resilience is determined by self-efficacy (SD=0.06), and 61% of the variance of spiritual health is determined by resilience (SD=0.06). From the direct path, 16% of the variance of spiritual health is determined by self-efficacy (SD=0.06).</p> Conclusions <p>The findings of the present study indicated that elderly patients with myocardial infarction do not possess an adequate level of self-efficacy, spiritual health, and resilience. Accordingly, healthcare providers are expected to adopt targeted interventions—such as spiritual counseling, resilience-enhancing workshops, and multifaceted approaches—in order to promote these three variables. Furthermore, the results demonstrated that resilience plays a significant mediating role in the relationship between spiritual health and self-efficacy. Therefore, it is recommended that healthcare managers and policymakers consider resilience as a critical component of the care process for these patients when allocating resources and developing relevant protocols.</p>