Cardiac care interventions that involve patients and their partners may increase adherence to healthy behaviors, boost mental health, and improve some cardiovascular outcomes, a review of clinical trials has found.

The study, published online on December 15 in the Canadian Journal of Cardiology, was led by Heather Tulloch, PhD, director of the Cardiovascular Health Psychology and Behavioural Medicine Laboratory at the University of Ottawa Heart Institute, Ottawa, Ontario, Canada. She was inspired to investigate the topic by the number of partners who have contacted her over the years seeking help in supporting a patient’s recovery.

“Heart disease doesn’t happen in a vacuum; it affects the patient’s partner and family as well,” she told Medscape Medical News.

Tulloch and her colleagues reviewed 16 articles that reported on 12 randomized controlled trials of mostly nurse-led, behaviorally focused interventions involving patients and their partners. They evaluated the effectiveness of couples-based interventions on modifiable cardiovascular risk factors, cardiac outcomes, mental health, and relationship quality.

The interventions were mostly nurse-led education efforts regarding modifiable risk factors, including diet, smoking, exercise, and medication adherence. Researchers looked at interventions that included partners participating in at least half of the sessions.

The study found that couples-based interventions seem to be effective in improving health behaviors — 77% of the studies reported such improvements — while there were mixed effects for mental health outcomes. There were also improvements in some cardiovascular outcomes such as lipid profiles, but the results were inconsistent. Just three studies looked at relationship quality, and none found any improvement.

The results demonstrate the importance of including partners in cardiac care but also highlight the need to do so more systematically and to better study the effects. “Health behaviors are better when we include partners and some mental health outcomes too, especially depression,” she said. “But we need more studies to know whether it improves cardiac and relationship outcomes.”

Julianne Holt-Lunstad, director of the Social Connection & Health Lab at Brigham Young University in Provo, Utah, said the mixed results are probably the result of the relatively short follow-up time of most of the studies, especially when it comes to cardiovascular outcomes. “I wouldn’t conclude that there was no effect, but the follow-up may not have been long enough to see the effect on cardiac events,” she said in an interview.

A 2021 meta-analysis by Holt-Lunstad that looked at the effects of psychosocial support on mortality more broadly found a 20% increased likelihood of survival among patients receiving psychosocial support compared with those receiving standard medical care.

Tamara Sher, PhD, clinical psychologist at Rosalind Franklin University in Chicago who specializes in couples’ health, said she was glad to see more attention being paid to this important topic. “My study [on a couples approach to cardiac care] was published in 2014, and there hasn’t been too much done since then,” she said.

But Sher highlighted that the focus on how strong relationships could improve health outcomes was missing any discussion of the possible reciprocal correlation — people who are healthy are more likely to be married, for example, and strong relationships could be the result of good health because they avoid the stress associated with poor health.

To take advantage of the ways social relationships can benefit heart health, Tulloch’s study recommends a stepped care model: Providers assess the presence and quality of patients’ intimate relationships and offer interventions such as education on the importance of social support or even relationship counseling and couples therapy. Sher strongly endorsed this idea.

“We need to think about the context to which a patient is returning, not just their treatment in hospital,” she said. “Could that context be improved?”

Tulloch’s own intervention, Healing Hearts Together, teaches couples about the importance of relationships for heart health. It helps them connect more and has shown promise in improving relationship quality, mental health, and quality of life in a proof-of-concept study. It is currently being evaluated in a larger clinical trial.

“We are social beings, and where there is distress, it impacts our health, particularly our heart health,” Tulloch said.

That makes the findings of a recent survey by Holt-Lunstad all the more worrying. The 2025 Social Connection in America survey found that more than 50% of respondents reported significant indicators of social isolation. In general, Americans are having less social contact, their networks are smaller, and they do not get together as often.

“As this evidence shows the widespread level of social isolation in our nation, that has important implications for long-term health outcomes, including cardiovascular disease,” she said.

Tulloch and Sher reported having no relevant financial relationships. Holt-Lunstad’s social connections survey and report were funded by the Barnes Family Foundation.

Brian Owens is a freelance journalist based in New Brunswick, Canada.