Cardiovascular disease is a leading cause of death in most western nations. Cardiac caregivers, defined as those who provide unpaid care to a loved one with cardiovascular disease, contribute substantially to a patient’s recovery. But at what cost to the caregiver? Recent reports in Canada, for example, indicate that 40% of caregivers experience high stress. If this stress is left unaddressed, there can be deleterious outcomes on caregivers’ physical and mental health. There is emerging research that cardiac caregivers, ironically, are vulnerable to developing their own poor cardiovascular health. This is especially the case for caregivers who are older in age, provide many hours of caregiving per week, and are dealing with their own health issues. Spousal caregivers are particularly at risk as they often share similar lifestyle factors as their patient-partner yet often regard the cardiac patient’s lifestyle changes as more critical than their own.
The links between caregiver stress and physiological and health-behaviour factors involved in cardiovascular risk are rapidly emerging. For example, recent research indicates that caregiver stress is independently associated with a 2-fold increase in risk in developing coronary heart disease, especially among women caregivers. Chronic stress brought on by a caregiving role increases caregivers’ cardiovascular reactivity (i.e., blood pressure, heart rate) and can impair endothelial function. Most alarmingly, caregivers reporting high stress are 2.64 times more likely to die of cardiovascular disease compared to caregivers reporting low or no stress. Many caregivers experience disordered sleep, demonstrate poor medication adherence, spend less time engaging in self-care activities, and are less likely to be physically active than individuals who provide no or low levels of care.
Taken together, evidence continues to accumulate linking caregiver stress with poor cardiovascular health, which underscores the need for intervention strategies to minimize potential declines in caregivers’ health status. Unfortunately, little has been published on approaches that demonstrate effectiveness in reducing the physical and emotional burden of caregivers. While our awareness of the risks of caregiving is improving, the question still remains: how do we strengthen this vulnerable population?
We argue that improving patient-caregiver relationship quality may be one such approach. We know from decades of research in health psychology and relationship science that improved spousal relationship quality can lead to enhanced mental health and even physical health. For example, partners in satisfying relationships are 3.2 times more likely to be alive 15 years after coronary artery bypass grafting than those in unsatisfying relationships. Supportive spouses model heart-healthy behaviours, such as consuming vegetables and engaging in physical exercise. There is also evidence that high quality caregiver-patient relationships can reduce caregiver burden and depressive symptoms, allowing caregivers to better care for themselves and their spouse. Addressing relationship quality within secondary prevention programming (such as cardiac rehabilitation) may afford an opportunity to enhance both a caregiver’s and cardiac patient’s overall health.
We recently developed a relationship-enhancement program, Healing Hearts Together, which aims to increase emotional accessibility and responsiveness in couples facing cardiovascular disease. Our pilot data indicates that both patients and partners experienced significant improvements in relationship quality, mental health, and quality of life. A controlled evaluation of the impact of this program on cardiovascular risk factors and outcomes is underway. Future research should continue to investigate effective approaches to support caregivers.
We can no longer keep the health of caregivers invisible. It is high time to fully recognize the role of caregivers in patients’ recovery and to acknowledge that caregivers may also be in need. We must care for those who care for their loved ones and enhance the health of both.
Bouchard, K., Greenman, P., Pipe, A., Johnson, S., and Tulloch, H. Reducing caregiver distress and cardiovascular risk: a focus on caregiver-patient relationship quality. (In press) Can J Cardiol. 2019.