Objective: To explore the effects of integrating metabolic equivalent-based exercise rehabilitation with exercise-psychological-sleep nursing in elderly patients with coronary heart disease complicated by heart failure. Methods: A total of 70 patients meeting the inclusion criteria were selected and randomly divided into a control group (n = 35, receiving conventional cardiac rehabilitation nursing) and an observation group (n = 35, receiving metabolic equivalent-based exercise rehabilitation nursing combined with exercise-psychological-sleep integrated intervention) using a random number table method. Mental health indicators, cardiac rehabilitation indicators, and sleep quality indicators were observed and compared between the two groups before and after nursing. Results: After nursing, the observation group had significantly lower SAS scores, SDS scores, and PSQI scores, as well as higher 6MWT and METs levels compared to the control group (p < 0.05). Conclusion: Metabolic equivalent-based exercise rehabilitation nursing combined with exercise-psychological-sleep integrated intervention can effectively alleviate anxiety and depression in patients, promote cardiac function recovery, optimize sleep status, and demonstrate clear long-term effects, indicating significant value for clinical promotion.