BACKGROUND: Elderly patients with coronary heart disease (CHD) are prone to psychological disorders during treatment. Strengthening psychological well-being can improve rehabilitation outcomes. This study aimed to explore the effects of recording positive events on anxiety, psychological capital, treatment compliance, and major adverse cardiovascular events (MACE) in elderly CHD patients with anxiety symptoms. METHODS: A total of 309 elderly CHD patients with anxiety were enrolled and randomly assigned to an intervention group (n=154) and a control group (n=155). After the intervention, assessments were conducted using the Self-Rating Anxiety Scale (SAS), the Positive Psychological Capital Questionnaire (PPQ), and a treatment compliance scale, along with collection of clinical indicators and data on MACE. Primary outcomes were changes in anxiety and treatment compliance behaviors. Secondary outcomes included changes in the positive psychological capital scores, clinical indicators, and incidence of MACE. RESULTS: The intervention group showed significantly lower anxiety scores than the control group at the end of the intervention (3 months after discharge) and the end of follow-up period (6 months after discharge) (p<0.05). Additionally, the intervention group scored significantly higher on the PPQ and CHD Treatment Compliance Behavior Scale (p<0.05). Improvements in clinical indicators (except systolic blood pressure) were significantly greater in the intervention group (p<0.05). Furthermore, the incidence of MACE was significantly lower in the intervention group (12 cases vs. 36 cases, p<0.05), and compared with the control group, the relative risk (RR) of adverse cardiovascular events was 0.33 (95% confidence interval: 0.18-0.61, p = 0.025). CONCLUSION: Recording positive events can alleviate anxiety, enhance psychological capital and treatment compliance, reduce the occurrence of MACE, and effectively improve rehabilitation outcomes in elderly CHD patients.