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Objective (s): Acute coronary heart disease is the most common cause of death in the elderly. The purpose of this study was to determine the effectiveness of spiritual therapy on quality of life in elderly patients with acute coronary heart disease. Methods: This was a quasi-experimental study with pre-test and post-test design on a sample of 54 elderly people with acute coronary heart disease in Tehran who were selected by convenience sampling method and then were randomly assigned to two groups including 27 intervention and 27 control group. The intervention group received 8 sessions of 60 minutes’ spiritual therapy and the control group did not receive the intervention. Elderly participants in the study completed the Elderly Quality of Life Questionnaire (CASP-19) and Seattle Angina Quality of Life Questionnaire (SAQ) before, one week and one month after the intervention. Results: The results showed that spiritual therapy was significantly effective on quality of life of the elderly with acute coronary heart disease using the total score of both Seattle questionnaire the elderly quality of life questionnaire(CASP-19) indicating that the interaction between group and time was significant (P <0.05). Conclusion: Spiritual therapy was effective in promoting quality of life in elderly patients with acute coronary heart disease (between groups and time progression).