Objective: To study the changes and clinical effects of elderly patients with coronary heart disease and chronic heart failure after applying individualized cardiac rehabilitation. Methods: 85 cases of elderly patients with coronary heart disease and chronic heart failure admitted from June 2023 to May 2024 were divided into the control group (42 cases) and the experimental group (43 cases), and were given conventional rehabilitation guidance and individualized cardiac rehabilitation training programme respectively, comparing the indexes of exercise endurance, level of cardiac function, quality of life, and incidence of adverse cardiovascular events in the two groups. Results: Before intervention, the LVEF, LVEDD and LVEDS of the control group and the experimental group were (37.11 ± 3.96)%, (62.15 ± 4.06) mm and (45.75 ± 4.33) mm and (37.06 ± 3.92)%, (2.20 ± 4.23) mm and (45.81 ± 4.27) mm, respectively, with no statistically significant difference. and test group LVEF increased and LVEDD and LVESD decreased by (45.75 ± 5.12)%, (55.18 ± 3.97) mm, (41.14 ± 3.29) mm and (51.79 ± 4.26)%, (48.23 ± 3.58) mm, (36.62 ± 3.75) mm, respectively, with statistically significant differences between the groups (P < 0.05) ). Before intervention, the 6 min walk test (6MWT) and maximum exercise load of the control group and the experimental group were (325.55 ± 37.79) m, (91.02 ± 15.74) W and (324.17 ± 37.68) m, (90.92 ± 14.78) W, respectively, and the difference was not statistically significant (P > 0.05). After intervention, all the indicators of both groups were significant (P > 0.05). After the intervention, all indicators in both groups were significantly higher, respectively (386.28 ± 42.95) m, (135.67 ± 22.75) W and (460.43 ± 39.91) m, (152.83 ± 25.64) W, and the difference between the groups was not statistically significant (P < 0.05). The quality of life scores of the experimental group on somatic symptoms, daily activities, psychological quality, and social functioning were respectively (80.01 ± 6.02), (73.75 ± 7.32), (80.56 ± 6.41), (71.42 ± 6.87), significantly higher than the control group’s (67.03 ± 6.98), (64.19 ± 7.16), (63.78 ± 6.13) and (60.72 ± 6.47), while the difference was statistically significant (P < 0.05).  Cardiac arrhythmia occurred in the experimental group. The incidence of adverse cardiovascular events such as myocardial infarction was 4.65%, which was significantly lower than that of the control group (23.81%), and the difference was statistically significant (P < 0.05). Conclusion:  Individualized cardiac rehabilitation exercise in elderly patients with coronary heart disease and chronic heart failure can promote the recovery of clinical symptoms, improve cardiorespiratory function, enhance exercise endurance, improve the quality of life, and effectively improve the prognosis.