Couples-based programs boost heart-healthy behaviors

Involving partners in heart disease treatment boosts lifestyle change and coping, but a new review finds that most programs still fall short of addressing emotional and relationship factors that may be critical for long-term heart health.

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

Cardiac diseases and preventive strategies

Cardiovascular disease (CVD) is a leading cause of death. In Canada, 1 in 12 adults above 20 years of age is diagnosed with heart disease. Similarly, in the European Union, CVD accounts for one-third of all deaths and 20 % of deaths among those who are under 65 years. Recent studies have also linked CVD with depression, anxiety, and posttraumatic stress in patients and their partners, compounding its impact.

Cardiac disease prevention has traditionally focused on individual risk factors, with treatment centered on the patient. More recently, psychosocial factors, including mental health, social isolation, and positive social support, are recognized as key predictors of CVD.

Social isolation significantly increases cardiovascular risk. Meta-analyses show that loneliness and low social contact are linked to higher rates of coronary artery disease and heart failure. These risks extend beyond individuals, straining healthcare systems through increased doctor visits, hospitalizations, and longer hospital stays.

Notably, a 2010 meta-analysis showed a 50 % higher survival rate among those 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, and behavioral factors (e.g., smoking and physical activity) in CVD risk. Research also reveals that social support reduces all-cause and cerebrovascular mortality, protects against CVD onset, and lowers hospital readmission rates for patients with heart disease.

Do couple relationships impact CVD?

Relationship quality also shapes health behaviors. For instance, those with high-quality relationships were linked with more physical activity, healthier diets, less smoking, lower obesity, and better treatment adherence.

Emotionally healthy relationships help regulate emotions, supporting a healthy heart rate and blood pressure, and reducing vulnerability to depression and anxiety. In contrast, distressed relationships foster negative emotions like anger, which can harm vascular health. Since mood and anxiety disorders worsen cardiac outcomes, emotional support from a partner is vital for heart health.

Although a couple's relationship quality influences the development, progression, and recovery from CVD, about 30 % of people with CVD report relationship distress, underscoring the need for interventions that improve relationship quality to boost heart health.

Couple-based interventions enhance health behaviors, but unclear cardiac and mental health outcomes

The current review obtained 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 with 1,444 patient-partner pairs, mostly diagnosed with coronary artery disease. It is worth noting that most studies were conducted in the U.S. or Sweden and primarily involved White participants.

The interventions were led mainly by nurses. In most studies, interventions began during or soon after hospitalization and ranged from brief (a few days) to longer (up to six months), with the majority lasting approximately three months. The majority were delivered in person, with some involving 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 for patients with heart conditions and their partners. Positive effects were seen in most studies assessing health behaviors (77 %) and mental health (63 %). However, these effects were inconsistent across outcomes and studies, and no significant benefits for RQ were found when only RCTs were considered.

Most interventions involved basic partner participation, like attending educational or counseling sessions together. While this can encourage shared motivation, it may be less effective for couples with different health habits, potentially leading to increased tension. The lack of significant mental health improvements may reflect the fact that most interventions were not designed to directly target emotional regulation or relationship dynamics, which are known to influence psychological well-being.

Patients generally experienced more improvement than their partners, but targeted support reduced depression and anxiety for partners in at least one study. This finding suggests that partner-specific or caregiver-focused interventions may be necessary to support partners’ psychological health, particularly during the acute phase of cardiac illness.

Next steps

Couple-based interventions are effective in improving health behaviors, but they show mixed results for mental health and cardiac outcomes. Most studies were underpowered to detect differences in major cardiac events, highlighting the need for larger trials with well-defined endpoints.

Future interventions should focus more on emotional and relational aspects, recognizing the strong connection 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 stepped care model could help match intervention intensity to each couple’s specific needs, making resource use more efficient.

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Journal reference:

• Tulloch, H. E. et al. (2025) What About Love? A Review of Interventions for Patients With Heart Disease and Their Intimate Partners: Recommendations for Cardiac Rehabilitation. Canadian Journal of Cardiology. DOI: 10.1016/j.cjca.2025.09.014 . https://onlinecjc.ca/article/S0828-282X(25)01166-3/fulltext