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To assess the effect of nurse-led cardiac rehabilitation programs on improving the quality of life of elderly patients with coronary artery disease (CAD). This single-center retrospective cohort study included elderly CAD patients hospitalized and followed at our hospital from June 2022 to June 2024. Based on receipt of a nurse-led rehabilitation program, patients were assigned to a rehabilitation or conventional group. Propensity score matching (1:1 nearest neighbor) was performed using variables including age, gender, major comorbidities (hypertension, diabetes, and hyperlipidemia), body mass index, smoking status, NYHA class, left ventricular ejection fraction, history of percutaneous coronary intervention/coronary artery bypass grafting, and baseline medication use. The program comprised individualized assessment and goal setting before discharge, plus remote support, and self-management training after discharge. Primary outcome was the SF-36 quality of life score; secondary outcomes were Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Six-Minute Walk Test. Assessments were at discharge, 3 months, and 6 months. After matching, baseline characteristics were balanced between the 2 groups. There were no significant differences between the rehabilitation group and the conventional group in age (71.6 ± 6.4 vs 72.1 ± 6.1 years), gender (male 61.3% vs 64.5%), comorbidity of hypertension (72.6% vs 75.8%), and percutaneous coronary intervention ratio (50.0% vs 48.4%) (all P > .05). At 6 months of follow-up, the rehabilitation group showed a significant improvement in SF-36 total score (from 58.2 ± 7.4-75.6 ± 5.8), which was better than the conventional group (from 57.6 ± 6.9-65.2 ± 6.5) (interaction P = .023). The most significant improvements were observed in physical function and social function (interaction P = .017 and 0.026, respectively). The physical function score in the rehabilitation group at 6 months was 78.9 ± 6.2, significantly higher than the conventional group's score of 68.5 ± 6.9. The Generalized Anxiety Disorder-7 score in the rehabilitation group decreased from a median of 7 at discharge to 3 at 6 months (IQR 2-5), while the conventional group remained at 6 (IQR 4-8), with a significant difference (P < .01). A similar trend was observed in Patient Health Questionnaire-9 scores. The 6-minute walking distance also showed greater improvement in the rehabilitation group (from 298.5 ± 45.2-385.7 ± 38.4 m, P < .001). Nurse-led cardiac rehabilitation significantly improves quality of life, reduces anxiety and depression, and enhances functional capacity in elderly CAD patients, supporting its broader clinical application.