Abstract Aims Despite therapeutic advancements, the prognosis of heart failure (HF) remains poor, with high rates of mortality and readmission, particularly following a HF exacerbation. This study aimed to evaluate the effects of a nurse‐coordinated multidisciplinary comprehensive HF management programme on HF patients. Methods and results This retrospective cohort study involved patients admitted for acute HF exacerbation at a regional hospital in Hong Kong. We established two patient cohorts: the control cohort, recruited between January and December 2021, received standard care, while the programme cohort, recruited from October 2022 to December 2023, participated in a comprehensive programme. This programme included multidisciplinary ward rounds, early initiation of guideline‐directed medical therapy (GDMT), discharge education, post‐discharge transitional care and cardiac rehabilitation. The primary outcome was the composite endpoint of all‐cause mortality and HF‐related readmission at 6 months. Secondary endpoints included HF‐related readmission and all‐cause mortality. We also assessed patient satisfaction and health‐related quality of life (HRQoL) in the programme cohort. The study included 732 patients, 24.0% female, 81.6% with HFrEF, mean age of 67.9 ± 13.2 years. After matching for age, sex and type of HF, 366 patients were allocated to each cohort. The programme cohort demonstrated significantly lower rates of the composite endpoint [12.0% vs. 38.0%, adjusted hazard ratio (aHR) = 0.26, 95% confidence interval (CI) = 0.19–0.37, P < 0.001]) and HF‐related readmissions (10.1% vs. 25.4%, aHR = 0.36, 95% CI = 0.24–0.52, P < 0.001) compared with the control cohort. All‐cause mortality was also significantly reduced (4.4% vs. 18.3%, aHR = 0.22, 95% CI = 0.13–0.38, P < 0.001). Improvements in HRQoL and high patient satisfaction were noted in the programme cohort. Conclusions The nurse‐coordinated comprehensive HF management programme significantly reduced readmissions and mortality, with consistent benefits across different subgroups. Further research is needed to confirm these benefits and explore mechanisms.