Couple-based programs promote heart-healthy behaviors

Couple-based programs promote heart-healthy behaviors

Involving partners in heart disease management promotes lifestyle changes and heart disease management. But new research finds that most programs still don't take into account the emotional and relationship factors that can be crucial to long-term heart health.

Study: What about love? A review of interventions for patients with heart disease and their partners: recommendations for cardiac rehabilitation. Photo credit: PeopleImages/Shutterstock.com

A recent systematic review examined how couple-based interventions impact modifiable cardiovascular risk factors, cardiac outcomes, mental health, and relationship quality (RQ) in adults diagnosed with heart disease and their partners. The results were published inCanadian Journal of Cardiology.

Heart disease and prevention strategies

Cardiovascular disease (CVD) is one of the most common causes of death. In Canada, one in twelve adults over the age of 20 are diagnosed with heart disease. In the European Union, cardiovascular diseases also account for a third of all deaths and 20% of deaths in people under 65 years of age. Recent studies have also shown that cardiovascular disease is associated with depression, anxiety and post-traumatic stress in patients and their partners, compounding its impact.

Heart disease prevention has traditionally focused on individual risk factors, with treatment tailored to the patient. More recently, psychosocial factors, including mental health, social isolation, and positive social support, have been recognized as important predictors of cardiovascular disease.

Social isolation significantly increases cardiovascular risk. Meta-analyses show that loneliness and low levels of social contact are associated with higher rates of coronary heart disease and heart failure. These risks extend beyond the individual and place strain on healthcare systems through increased doctor visits, hospitalizations and longer hospital stays.

Notably, a 2010 meta-analysis found a 50% higher survival rate among people with stronger relationships. The magnitude of the effect was found to be similar to that of traditional biomedical factors such as cholesterol and body mass index, as well as behavioral factors (e.g. smoking and physical activity) on CVD risk. Research also shows that social support reduces all-cause and cerebrovascular mortality, protects against the onset of cardiovascular disease, and reduces hospital readmission rates for patients with heart disease.

Do couple relationships have an impact on cardiovascular disease?

Research has shown that support from a spouse or partner has a particularly positive impact on heart health. A recent meta-analysis found that unmarried people are more than 40% more likely to develop cardiovascular disease or die from a heart attack than married people. However, relationship quality (RQ), which refers to the level of warmth, support, and closeness compared to conflict and distance, is just as important as relationship status. A previous longitudinal study has linked high-quality couple relationships to reduced cardiac response to stress and better health outcomes, including improved diabetes control, healthier weight, better nutrition and lower blood pressure.

Relationship quality also influences health behavior. For example, people with good relationships have been linked to more physical activity, healthier diets, less smoking, less obesity and better adherence to medication.

Emotionally healthy relationships help regulate emotions, support a healthy heart rate and blood pressure, and reduce susceptibility to depression and anxiety. In contrast, strained relationships promote negative emotions such as anger, which can be harmful to vascular health. Because mood and anxiety disorders worsen cardiac outcomes, emotional support from a partner is critical to heart health.

Although a couple's relationship quality influences the development, progression, and recovery of cardiovascular disease, approximately 30% of people with cardiovascular disease report relationship problems, highlighting the need for interventions that improve relationship quality to promote heart health.

Couple-based interventions improve health behaviors but have unclear effects on cardiac and mental health

The current review used all relevant research articles from the MEDLINE database to understand whether couples-based interventions improve cardiac or mental health outcomes in adults with heart disease and their partners. The final review included 12 RCTs involving 1,444 patient-partner pairs, most of whom were diagnosed with coronary artery disease. It is worth noting that most studies were conducted in the United States or Sweden and included primarily white participants.

Interventions were primarily nurse-led. In most studies, interventions began during or shortly after hospitalization and ranged from short duration (a few days) to longer duration (up to six months), with most lasting approximately three months. The majority were conducted face-to-face, some involved group sessions, and were often compared to usual care or patient-only interventions. Telephone follow-up was also used in some studies.

Overall, couples-based interventions can improve health behaviors and coping in patients with heart disease and their partners. Positive effects were observed in most studies assessing health behavior (77%) and mental health (63%). However, these effects were inconsistent across outcomes and studies, and no significant RQ benefits were found when only RCTs were considered.

Most interventions included basic partner involvement, such as attending educational or counseling sessions together. While this can promote mutual motivation, it may be less effective for couples with different health habits, potentially leading to increased tension. The lack of significant improvements in mental health may be due to the fact that most interventions do not directly target emotional regulation or relationship dynamics, which are known to influence psychological well-being.

Patients generally experienced greater improvement than their partners, but targeted support reduced depression and anxiety in partners in at least one study. This finding suggests that partner-specific or caregiver-focused interventions may be necessary to support partners' mental health, particularly in the acute phase of heart disease.

Next Steps

Couple-based interventions are effective in improving health behaviors but show mixed results for mental health and cardiac outcomes. Most studies were not sufficiently powered to detect differences in major cardiac events, highlighting the need for larger studies with clearly defined endpoints.

Future interventions should focus more on emotional and relational aspects and recognize the strong association between relationship quality and heart health. Research should also address gaps related to underserved populations, comprehensive outcome measures for both partners, and the practical application of these measures in cardiac rehabilitation. A tiered care model could help tailor intervention intensity to each couple's specific needs, making resource use more efficient.

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