{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:50:03Z","timestamp":1790790603496,"version":"4.1.0"},"reference-count":52,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T00:00:00Z","timestamp":1588723200000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"International Centre for Excellence in Emotionally Focused Therapy (ICEEFT)."}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Cardiovascular disease (CVD) not only affects the patient, but has implications for the partner. Emerging evidence suggests that supportive couple relationships enhance CVD outcomes and reduce patient and partner distress. To date, however, little research has been done to address the couple relationship as a potentially important component of cardiac care. This article examines the impact of CVD on the couple relationship and assesses the perceived needs and desired intervention components of patients with CVD and their partners.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Qualitative study using directed and conventional content analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Single-centre, tertiary cardiac care hospital that serves a population of 1.4\u2009million in the Champlain region of Ontario, Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Patients with CVD and their partners (n=32, 16 couples) participated in focus groups. Patients were mainly male (75%), white (87.5%), aged 64.4 years (range 31\u201381 years), with varied cardiac diagnoses (50% coronary artery disease; 18.75% valve disease; 18.75% heart failure; 12.5% arrhythmia).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five categories were generated from the data reflecting changes within the couple relationship as a result of CVD: (1) emotional and communication disconnection; (2) overprotection of the patient; (3) role changes; (4) adjustment to lifestyle changes; and (5) positive relationship changes. Three categories were constructed regarding intervention needs and desired resources: (1) practical resources; (2) sharing with peers; and (3) relationship enhancement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall, the data suggest that there were profound changes in the couple relationship as a result of CVD, and that there is considerable need to better support the caregiving spouses and the couple as a unit. These results call for interventions designed to provide instrumental support, peer-sharing opportunities and relationship quality enhancement to help couples cope with CVD. Future studies should examine whether couples-based programming embedded into cardiac rehabilitation can be effective at improving relationship quality and reducing patient and partner stress in the aftermath of a cardiac event.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2019-032948","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T11:19:32Z","timestamp":1588850372000},"page":"e032948","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["Learning a new way of living together: a qualitative study exploring the relationship changes and intervention needs of patients with cardiovascular disease and their partners"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7466-8554","authenticated-orcid":false,"given":"Heather","family":"Tulloch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Bouchard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Clyde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Madrazo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Demidenko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Greenman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,6]]},"reference":[{"key":"2020050704192417000_10.5.e032948.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2011.11.019"},{"key":"2020050704192417000_10.5.e032948.2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308790"},{"key":"2020050704192417000_10.5.e032948.3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000316"},{"key":"2020050704192417000_10.5.e032948.4","doi-asserted-by":"crossref","DOI":"10.1371\/annotation\/79b46b67-786c-47cf-945e-915906ac2e55","article-title":"Psychological interventions for patients with coronary heart disease and their partners: a systematic review","volume":"8","author":"Reid","year":"2013","journal-title":"PLoS One"},{"key":"2020050704192417000_10.5.e032948.5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.biopsycho.2016.01.003","article-title":"Social support sources matter: increased cellular aging among adults with unsupportive spouses","volume":"115","author":"Barger","year":"2016","journal-title":"Biol Psychol"},{"key":"2020050704192417000_10.5.e032948.6","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1089\/jwh.2016.6103","article-title":"Marital status, cardiovascular diseases, and cardiovascular risk factors: a review of the evidence","volume":"26","author":"Manfredini","year":"2017","journal-title":"J Womens Health"},{"key":"2020050704192417000_10.5.e032948.7","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.ijcard.2016.03.066","article-title":"The impact of marital status on mortality and length of stay in patients admitted with acute coronary syndrome","volume":"212","author":"Hayes","year":"2016","journal-title":"Int J Cardiol"},{"key":"2020050704192417000_10.5.e032948.8","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/jftr.12182","article-title":"The natural principles of love","volume":"9","author":"Gottman","year":"2017","journal-title":"J Fam Theory Rev"},{"key":"2020050704192417000_10.5.e032948.9","unstructured":"Smith T , Baron C . 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