{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:46:03Z","timestamp":1794491163748,"version":"4.9.1"},"reference-count":24,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR203248"],"award-info":[{"award-number":["NIHR203248"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,18]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Single-blinded randomised controlled trial (RCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Cardiology department of a public tertiary-care hospital in Lahore, Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>120 patients aged 18\u201365 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u221218.72, 95% CI \u221221.00 to \u221216.40). These improvements were evident after 3 months and sustained at 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Australian New Zealand Clinical Trial Registry, ACTRN12623000049673p.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114349","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:20:42Z","timestamp":1782825642000},"page":"e114349","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of home-based cardiac rehabilitation on quality of life, health behaviours and cardiac anxiety in patients with coronary artery disease: findings from a single-blinded randomised controlled trial"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3712-1116","authenticated-orcid":false,"given":"Adnan","family":"Yaqoob","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery, The Aga Khan University, Karachi, Sindh, Pakistan"},{"name":"Department of Nursing Education, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan"},{"name":"Lahore School of Nursing, The University of Lahore, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7015-0413","authenticated-orcid":false,"given":"Laila","family":"Ladak","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamir Hameed","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziauddin University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7146-7183","authenticated-orcid":false,"given":"Aysha","family":"Almas","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asif","family":"Hanif","sequence":"additional","affiliation":[{"name":"University Institute of Public Health, The University of Lahore, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furqan Yaqub","family":"Pannu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Punjab Institute of Cardiology, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faizan","family":"Khemani","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, The Aga Khan University Medical College Pakistan, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wajeeha","family":"Sahar","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, The University of Faisalabad, Faisalabad, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubina","family":"Barolia","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"2026063005551912000_16.6.e114349.1","doi-asserted-by":"crossref","DOI":"10.21037\/atm.2019.07.61","article-title":"Barriers physicians face when referring patients to cardiac rehabilitation: a narrative review","volume":"7","author":"Elsakr","year":"2019","journal-title":"Ann Transl Med"},{"key":"2026063005551912000_16.6.e114349.2","first-page":"S82","article-title":"Cardiac Rehabilitation As A Dedicated Clinical Service: Recent Achievements and Remaining Challenges","volume":"72","author":"Zahid","year":"2022","journal-title":"Pakistan Armed Forces Medical Journal"},{"key":"2026063005551912000_16.6.e114349.3","doi-asserted-by":"crossref","unstructured":"Iyngkaran P , Appuhamilage PY , Patabandige G , et al . Barriers to cardiac rehabilitation among patients diagnosed with cardiovascular diseases- a scoping review. 2024. Available: https:\/\/doi.org\/10.20944\/preprints202402.0443.v1","DOI":"10.20944\/preprints202402.0443.v1"},{"key":"2026063005551912000_16.6.e114349.4","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.eclinm.2019.06.007","article-title":"Cardiac Rehabilitation Availability and Density around the Globe","volume":"13","author":"Turk-Adawi","year":"2019","journal-title":"EClinicalMedicine"},{"key":"2026063005551912000_16.6.e114349.5","doi-asserted-by":"crossref","first-page":"E48","DOI":"10.1097\/HCR.0000000000000715","article-title":"Availability, Density, and Unmet Need for Cardiac Rehabilitation Around the World","volume":"42","author":"Turk-Adawi","year":"2022","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2026063005551912000_16.6.e114349.6","first-page":"435","article-title":"Nurse-coordinated home-based cardiac rehabilitation for patients with heart failure: A scoping review","volume":"10","author":"Ruan","year":"2023","journal-title":"Int J Nurs Sci"},{"key":"2026063005551912000_16.6.e114349.7","doi-asserted-by":"crossref","DOI":"10.12659\/MSM.942803","article-title":"The Impact of Home Cardiac Rehabilitation on Quality of Life and Psychological Well-Being in Patients with Coronary Heart Disease: A Randomized Controlled Study","volume":"30","author":"Zheng","year":"2024","journal-title":"Med Sci Monit"},{"key":"2026063005551912000_16.6.e114349.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-073673","article-title":"Home-based cardiac rehabilitation: development, implementation and outcome evaluation in patients with coronary artery diseases in Lahore, Pakistan - a mixed-methods study protocol","volume":"13","author":"Yaqoob","year":"2023","journal-title":"BMJ Open"},{"key":"2026063005551912000_16.6.e114349.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 statement: updated guideline for reporting randomised trials","volume":"389","author":"Hopewell","year":"2025","journal-title":"BMJ"},{"key":"2026063005551912000_16.6.e114349.10","doi-asserted-by":"publisher","DOI":"10.1007\/BF00435980"},{"key":"2026063005551912000_16.6.e114349.11","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.apnr.2017.11.011","article-title":"Validation of the cardiac health behavior scale for Korean adults with cardiovascular risks or diseases","volume":"39","author":"Song","year":"2018","journal-title":"Appl Nurs Res"},{"key":"2026063005551912000_16.6.e114349.12","doi-asserted-by":"publisher","DOI":"10.1177\/1073191115597059"},{"key":"2026063005551912000_16.6.e114349.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2011.05.005"},{"key":"2026063005551912000_16.6.e114349.14","doi-asserted-by":"crossref","first-page":"601","DOI":"10.4103\/idoj.IDOJ_149_19","article-title":"Selection of Control, Randomization, Blinding, and Allocation Concealment","volume":"10","author":"Sil","year":"2019","journal-title":"Indian Dermatol Online J"},{"key":"2026063005551912000_16.6.e114349.15","doi-asserted-by":"publisher","DOI":"10.4300\/jgme-5-4-18"},{"key":"2026063005551912000_16.6.e114349.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e36200","article-title":"Multicomponent versus aerobic exercise intervention: Effects on hemodynamic, physical fitness and quality of life in adult and elderly cardiovascular disease patients: A randomized controlled study","volume":"10","author":"Poli","year":"2024","journal-title":"Heliyon"},{"key":"2026063005551912000_16.6.e114349.17","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac747"},{"key":"2026063005551912000_16.6.e114349.18","doi-asserted-by":"crossref","DOI":"10.1186\/1477-7525-2-3","article-title":"The MacNew Heart Disease health-related quality of life instrument: a summary","volume":"2","author":"H\u00f6fer","year":"2004","journal-title":"Health Qual Life Outcomes"},{"key":"2026063005551912000_16.6.e114349.19","doi-asserted-by":"crossref","DOI":"10.2196\/49257","article-title":"Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study","volume":"25","author":"Chen","year":"2023","journal-title":"J Med Internet Res"},{"key":"2026063005551912000_16.6.e114349.20","doi-asserted-by":"crossref","first-page":"100542","DOI":"10.1016\/j.mhpa.2023.100542","article-title":"Barriers & facilitators to physical activity in people with depression and type 2 diabetes mellitus in Pakistan: A qualitative study to explore perspectives of patient participants, carers and healthcare staff","volume":"25","author":"Arsh","year":"2023","journal-title":"Ment Health Phys Act"},{"key":"2026063005551912000_16.6.e114349.21","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-024-08369-5"},{"key":"2026063005551912000_16.6.e114349.22","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-83231-y","article-title":"Effectiveness of e-Health cardiac rehabilitation program on quality of life associated with symptoms of anxiety and depression in moderate-risk patients","volume":"11","author":"Bravo-Escobar","year":"2021","journal-title":"Sci Rep"},{"key":"2026063005551912000_16.6.e114349.23","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/2047487319871716","article-title":"The prevalence and impact of depression and anxiety in cardiac rehabilitation: A longitudinal cohort study","volume":"27","author":"Rao","year":"2020","journal-title":"Eur J Prev Cardiol"},{"key":"2026063005551912000_16.6.e114349.24","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1177\/2047487318778088","article-title":"Cardiac rehabilitation and symptoms of anxiety and depression after percutaneous coronary intervention","volume":"25","author":"Olsen","year":"2018","journal-title":"Eur J Prev Cardiol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-114349","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:20:54Z","timestamp":1782825654000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-114349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":24,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,30]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjopen-2025-114349"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-114349","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2025-114349.supp1","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}