The experience of heart disease in a partner resulted in a closer relationship for most couples
Q What are the effects of heart disease in a partner on a couple’s relationship?
Qualitative study using an interpretive phenomenological approach with multiple interviews.
24 couples who had been in a stable partnership for ⩾1 year, with 1 partner who had experienced an acute cardiac event and completed a cardiac rehabilitation programme in the previous year. Exclusion criteria included heart failure in the patient, terminal illness or mental disability in either partner, and current participation of the couple in counselling. Patients were mainly middle-aged, married men (mean age 61 y), and partners were their wives (mean age 58 y).
Couples were interviewed in their homes 3 times: an in-depth interview with the couple (mean 85 min), followed up within 6−8 weeks by individual interviews with each partner (mean 54 min). The semistructured interviews addressed disease onset, effects on everyday life, changes in the relationship, and meanings for present and future life. Interviews were recorded, transcribed verbatim, and analysed continuously to identify themes. Interpretations were validated by a peer group not involved in the study.
In all couples, the illness was a life changing event for both partners. Marital satisfaction and coping strategies present before the cardiac event influenced how each couple responded to living with heart disease.
Illness as a positive experience. Some couples felt that the cardiac event brought them closer together and helped them to become more attuned to each other. The patients believed that they had gained a second chance in life: “the MI was just perfect…I was so grateful to have survived.” The illness inspired patients to implement changes to make life less stressful, but they relied on their wives to help maintain those changes and make them aware when they were slipping back into old ways. The challenges of reorganising their lives to deal with living with heart disease took a lot of effort, but in the end, it improved their relationship.
Illness as a threat and a fearful experience. Other couples saw the illness as a threat to their previously well ordered, healthy lives: “Why did this happen to us? We always took good care of our health.” It made them aware that life is unpredictable and the future uncontrollable: “So we are always a bit worried. It is hard to plan for the future when he is not healthy.” On the other hand, the cardiac event inspired them to view the patient’s recovery as a shared responsibility and integrate even more healthy practices into their lives. Although they experienced insecurities, which they tried to hide from each other, the challenges of the illness brought them closer together.
Illness as an experience of missed chances. In a few couples, the opportunities provided by the cardiac event to make positive changes in their lives and improve their relationship were passed over. The patients felt that they had recovered from the illness and wanted to get back to a normal life. The partners had expectations for change that were not shared by their husbands, resulting in arguments and withdrawal from each other. The couples returned to their old style of relating to each other, with feelings of sadness and being misunderstood.
The experience of heart disease in a partner was viewed as positive by some couples and negative by others but resulted in a closer relationship for most couples.
- Carol Jillings, RN, PhD
Qualitative research on the effects of heart disease has made important contributions to clinicians’ understanding of patient and family responses to acute events and the changes that result. The study by Mahrer-Imhof et al adds an additional dimension to our knowledge by articulating the patterns used by couples to attach meaning to illness and interpret its significance—both good and bad—for their lives. This application of phenomenological study to the couple as a unit is unusual. The study provides a novel lens through which we can assess both the aftermath of a diagnosis of heart disease and its treatment and the ways in which couples accept or overlook, and then manage, opportunities for change.
Applying the findings to couples in which the patient is a woman is not appropriate because most patients with heart disease in this study were men. In addition, the patients had attended a cardiac rehabilitation programme, a factor that may have influenced their knowledge and insight. A noteworthy aspect of the findings is that the couples’ assessment and interpretation of cardiac disease went beyond the individual meanings that might be ascribed by each of the partners. Patterns of relating to one another and strategies of joint problem solving seem to augment and extend individual coping. Health professionals can help to optimise patient outcomes by focusing on the couple and melding their individual and relational needs in the context of cardiac rehabilitation.
These findings underscore the need for nurses to view cardiac illness, as opposed to disease, as a socially constructed experience in which change and adaptation are complex processes that require astute assessment and support.
For correspondence: Dr R Mahrer-Imhof, University of Basel, Basel, Switzerland.
Source of funding: Roche Research Foundation Basel.