OBJECTIVE: To evaluate the effectiveness of a contextually developed home-based cardiac rehabilitation (HBCR) programme on heart-related quality of life (QoL), cardiac health behaviours (CHB) and cardiac anxiety (CA) among patients with coronary artery disease (CAD) in Lahore, Pakistan. DESIGN: Single-blinded randomised controlled trial (RCT). SETTING: Cardiology department of a public tertiary-care hospital in Lahore, Pakistan. PARTICIPANTS: 120 patients aged 18-65 years diagnosed with coronary artery disease who had undergone percutaneous coronary intervention or medical management were recruited and randomly allocated to intervention (n=60) and control (n=60) groups. INTERVENTION: Participants in the intervention group received a nurse-led HBCR programme consisting of discharge education, structured physical activity and exercise guidance, dietary counselling, medication adherence support, and regular telephonic and physical follow-ups over 24 weeks. The control group received routine care and standard discharge advice. PRIMARY OUTCOME MEASURES: Primary outcomes were heart-related quality of life (MacNew HRQoL), cardiac health behaviours (Cardiac Health Behaviour Scale-21) and cardiac anxiety (Cardiac Anxiety Questionnaire-18), assessed at baseline, 3 months and 6 months postdischarge. RESULTS: At 6-month follow-up, the intervention group demonstrated significantly higher global QoL scores compared with the control group (mean difference 30.71, 95% CI 22.90 to 38.50). CHB scores were also significantly higher in the intervention group (mean difference 19.60, 95% CI 16.20 to 23.00). CA scores were significantly lower among participants receiving HBCR (mean difference -18.72, 95% CI -21.00 to -16.40). These improvements were evident after 3 months and sustained at 6 months. CONCLUSION: The nurse-led HBCR programme significantly improved QoL and CHB and reduced CA among patients with CAD. HBCR may provide an effective and scalable secondary prevention strategy in settings where centre-based cardiac rehabilitation services are limited. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry, ACTRN12623000049673p.