Objective: To investigate the impact of the combined application of bisoprolol and rivaroxaban on cardiac function in patients with coronary heart disease. Methods: This study employed a retrospective design, including 90 patients diagnosed with coronary heart disease and treated in our hospital from January 2022 to June 2024. The patients were divided into a combination group (receiving both bisoprolol and rivaroxaban, n = 44) and a control group (receiving bisoprolol alone, n = 46) based on their medication regimen. Baseline data, cardiac ultrasound indicators (left ventricular ejection fraction, left ventricular end-diastolic diameter), serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, 6-minute walk test distance, and the occurrence of major adverse cardiovascular events were collected through the electronic medical record system. Results: After treatment, the left ventricular ejection fraction in the combination group was significantly higher than that in the control group (P < 0.05), and the left ventricular end-diastolic diameter in the combination group was significantly lower than that in the control group (P < 0.05). The combination group had a significantly lower NT-proBNP level compared to the control group (P < 0.05). The 6-minute walk test distance in the combination group was significantly higher than that in the control group (P < 0.05). No significant statistical difference was observed in the occurrence of major adverse cardiovascular events between the two groups (P > 0.05). Conclusion: The combined treatment of bisoprolol and rivaroxaban for patients with coronary heart disease can better improve cardiac function and enhance exercise tolerance in patients.