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This study evaluates the effectiveness of refined nursing care in improving psychological well-being, medication adherence, and quality of life in patients with coronary heart disease (CHD) and angina pectoris and examines the moderating influence of social support on these outcomes. A retrospective cohort study was conducted involving CHD patients who received either refined nursing care or standard nursing during hospitalization and follow-up. Refined nursing care included psychological counseling, structured health education, personalized lifestyle guidance, and family-centered support. Patients were assessed for anxiety and depression using the GAD-7 and PHQ-9 scales, respectively. Medication adherence and quality of life were measured using validated tools. Propensity score matching (PSM) was applied to minimize baseline differences. Comparative and regression analyses were used to assess outcomes and interaction effects. A total of 90 matched patients (45 in each group) were included in the final analysis. Patients receiving refined nursing care showed greater reductions in anxiety (mean change: -2.2, P < .05) and depression scores (-3.0, P < .05) compared to controls. Social support significantly enhanced the psychological benefits of refined nursing care (P < .001). Medication adherence improved notably in the refined care group (P < .05), with moderate correlations observed between reduced psychological distress and better adherence. Quality of life also improved more significantly in the refined group (P = .03). Notably, psychological benefits were evident even among patients without improvements in cardiac function. Refined nursing care effectively improves psychological status, enhances medication adherence, and promotes quality of life in CHD patients. Strong social support amplifies these effects. These findings support the integration of comprehensive, patient-centered nursing models into routine cardiovascular care.