Abstract Background: Congestive heart failure patients at coronary care unit suffer from many problems, which might endanger their life as increased anxiety level which originated from disease process and the actual care they receive was complex. Modified Care pathway guidelines are tools that enhance the patient quality of care by decreasing level of anxiety which may lead to increasing patient satisfaction. Therefore, the aim of this study is to evaluate effect of modified clinical pathway guidelines on congestive heart failure patients' satisfaction at Coronary Care Unit. Design: Quasi-experimental research design. Setting: Coronary Care Unit at Assuit University Hospitals. Sample: sixty adult males and females' critically ill patients' who divided into two equal and matched groups (study and control). Tools:- Three tools; Tool I: Personal and medical datasheet, Tool II Assessment of patient anxiety using state-trait anxiety inventory, and Tool III Patients' Satisfaction Scale. Results: Finding of this study supported stated research hypotheses with statistical significant difference between study and control groups regarding total mean of anxiety score at 6th day of intervention were (39.6±6.7, 44.87±4.54) respectively as well as (50%) of study group patients were very satisfied as compared with (3.3%) of control group. Conclusion: Applying modified clinical pathway guidelines significantly reduce anxiety level in congestive heart failure critically ill patients and improve patient's satisfaction. Recommendation: Conducting training programs about importance of modified clinical pathway guidelines implementation for all health care providers.