Objective This study aimed to explore the current status of home-based fatigue among patients after cardiac surgery and analyze its influencing factors. Methods From January 2023 to December 2023， we retrospectively collected data from 200 patients who underwent cardiac surgery and were discharged for more than 3 months from Guangdong Provincial People's Hospital. The Multidimensional Fatigue Inventory-20， Overall Pain Assessment Scale， Cardiac Rehabilitation Inventory and Self-efficacy for Managing Chronic Disease 6-Item Scale were used to assess the patients. Results Overall fatigue of patients at home after cardiac surgery was at a moderate level. A stepwise multiple linear regression analysis revealed that anxiety during cardiac rehabilitation （β = 7.476， P = 0.001）， severe pain （β = 11.939， P = 0.001）， and frequency of discomfort symptoms （P < 0.001） significantly positively predicted post-cardiac surgery fatigue， whereas self-efficacy in chronic disease management （β = -6.974， P < 0.001） significantly negatively predicted it. Conclusions Fatigue among home-based patients after cardiac surgery requires further improvement and is associated with cardiac rehabilitation anxiety， pain severity， self-efficacy， and frequency of discomfort symptoms. Healthcare providers could develop targeted continuity interventions based on these influencing factors to reduce fatigue levels and promote recovery among home-based patients after cardiac surgery.