Cardiac rehabilitation (CR) is a key component of secondary prevention in cardiovascular care. While its effects on clinical outcomes are well established, the long-term impact on health-related quality of life (HRQoL) and the specific contribution of nurse-led care remain underexplored in real-world settings.

To evaluate longitudinal changes in HRQoL among patients who completed a structured nurse-led CR program, and to identify subgroup differences and predictors of sustained improvement.

A prospective cohort study was conducted with 181 patients following myocardial infarction or cardiac surgery. HRQoL was assessed using the SF-36 questionnaire at four time points: baseline, discharge, 6 months, and 12 months. Sociodemographic, clinical, and psychosocial variables were analyzed. Nurse-led interventions were guided by standardized NIC classifications, including health education (NIC 5240), cardiac rehabilitation (NIC 5246), and emotional support (NIC 5270).

HRQoL improved significantly across all SF-36 domains over 12 months (p < 0.001), especially in physical functioning, vitality, and general health. Women, patients with low education, and those with baseline anxiety showed lower initial scores but meaningful gains. Adherence to the full program was strongly associated with sustained improvements.

Nurse-led CR is effective in promoting sustained HRQoL gains across physical and emotional domains. Standardized interventions based on NIC contribute to structured, person-centered care delivery, especially in vulnerable populations.

Implications for nursing practice

Monitoring HRQoL through validated tools and NIC-guided nursing plans enhances long-term cardiovascular recovery. Integration of psychosocial assessment and extended follow-up may improve equity and personalization in post-cardiac care.