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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.