A third of people who suffer heart attacks discover new meaning to their lives and reconnect with their partner, but others see it as a threat to their well-ordered existence, according to research published in the latest Journal of Advanced Nursing.

Researchers from Switzerland and the USA teamed up to explore the in-depth experiences of 24 couples to see whether the experience had changed their lives and their relationships.

"All the couples experienced a brush with death at the onset of the disease which called for changes in their lifestyle" says lead researcher Dr Romy Mahrer-Imhof, from the Institute of Nursing at the University of Basel, Switzerland.

"Three distinct patterns of dealing with the patient's heart attack emerged. People either made positive changes to their lives, felt negative about the experience or tried to turn their lives around but failed."

Nine couples reported that the heart attack was an important and necessary event which had brought them closer together and transformed their lives.

"He used to be a very normal person but then he became reserved" said one partner. "When he suffered the heart attack he emerged transformed. He is much more open, much more relaxed. Now we can speak together again. We have succeeded in turning our lives around."

This particular couple had also made practical changes to their lives.

"For example, I don't do the grocery shopping anymore" she adds. "He goes now with the bike • cycling is good for him and it brings him out from behind the computer."

Ten couples said that they felt fearful and threatened by the fact that they had no control over an unpredictable future.

"The physician who tested me said my heart is not good" said one patient." I could not understand it. Why did this happen to me? I was always careful to eat healthy food and I never smoked."

"We are always a bit worried" added his wife. "We planned a trip, but now we have to let that go. I know I don't need to be anxious, but it is hard to plan for the future when he is not healthy."

The remaining five couples looked at various possibilities for positive change as the result of the heart attack. But they did not achieve them and felt that they had missed their chance to make things better.

One partner in her mid 60s talked about how she wanted her husband to take more exercise, work less and spend more time with her after his heart attack.

"Work and other things are much more important than that we spend time together" she said. "I have to rely on myself. I do not want to wait and be frustrated all the time. I could start nagging - how awful. So we live as we did before."

The study focussed on patients who had been hospitalised in north-west Switzerland in the last year after an acute cardiac event, together with their partners. The patients had all attended a cardiac rehabilitation programme.

All the study couples had been in a stable relationship for at least a year and none had a coexisting terminal illness or mental disability or were receiving counselling at the time of the study.

83 per cent of the patients were married men, with an average age of 61, and their wives were slightly younger, with an average age of 58. Relationships ranged from four to 60 years, with a median of 35.

92 per cent had children and 50 per cent also had grandchildren.

The majority (92 per cent) had coronary heart disease and eight per cent had valve failure. 54 per cent received catheterisation, 38 per cent had surgery and eight per cent received other treatments.

The interviewers spoke to each couple together for about an hour and a half and followed this up with individual one-hour interviews with each of the 24 patients and their partners.

"Many patients, particularly women, don't attend rehabilitation programmes and this is something that needs to be addressed during their stay in hospital" says Dr Mahrer-Imhof.

"Our findings also support arguments for increasing the involvement of couples in rehabilitation programmes so that support can be tailored to their own individual relationship.

"For example, counselling could provide these couples with more choices about how to negotiate more intimacy in a relationship in which each partner's needs and wants are respected.

"Group session are also useful as they show people how other couples deal with similar situations, helping them to conquer fear and find new ways of living, despite the illness."