This review found that health service interventions that targeted relatives of patients with heart disease appeared to have positive effects on patients' and relatives' health and well-being. The small number of studies of doubtful quality meant that full evidence was lacking. These results need to be interpreted with some caution given limitations in the reported conduct of the review.

To review the literature published from 2000 on health service interventions targeting relatives of patients with heart disease

The authors searched MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane library (January 2000 to March 2006). Key words were documented in the report. They also examined reference lists of the retrieved literature. Studies needed to be written in English or a Scandinavian language.

Egible studies needed to meet the following inclusion criteria: focus on health service interventions for adults; focus on people recovering from heart disease; target close relatives of patients with heart disease; and focus on treatment and aftercare (rather than causes of disease).

Included studies were from USA and Canada. All had an educational component and aimed to ensure the well-being of either patients or relatives or both; most studies targeted both. Participant numbers varied from five to 296 couples. Definitions of relatives varied, but most were spouses. The studies were largely based on male patients and female relatives. Studies focused mostly on families affected by acute rather than chronic heart disease. The number and length of sessions in the programmes and content varied across the studies. Half of the studies took a quantitative approach and half took a qualitative approach to evaluation of outcomes. Studies mostly assessed mental well-being and/or satisfaction with treatment.

One reviewer selected studies for the review.

The authors did not state that they assessed validity.

The authors stated neither how data were extracted for the review nor how many reviewers performed the data extraction.

The authors used a narrative synthesis to discuss the effects of the interventions in the included studies.

Six studies were included in the review (total number of participants not reported): three randomised controlled trials and three qualitative studies.

All six studies showed positive effects of interventions that targeted relatives of patients with heart disease. Outcomes positively affected included: dietary sodium intake among patients participating with their relatives in a family-focused intervention (one study); and satisfaction, coping, spousal relationship, quality of life and perceived control among patients and relatives participating in relative or family interventions (four studies). Nurse-assessed activities that targeted relatives were found to be feasible and useful (two studies).

Health service interventions that targeted relatives of patients with heart disease appeared to have positive effects on patients' and relatives' health and well-being. However, the number and quality of the studies meant that overall evidence for effects was lacking.

The authors searched a range of databases and had documented inclusion criteria for participants, intervention and outcomes, but not for study design. The exclusion of unpublished material and of studies in languages other than English and Scandinavian languages opened up the possibility of publication and language biases. The authors did not conduct a validity assessment, so the reliability of individual studies was uncertain. The processes of study selection and data extraction were not documented in full; it was unclear whether more than one reviewer was involved in these processes, which raised the possibility of bias and error. A narrative synthesis was appropriate given the heterogeneity of the studies. The results of the review need to be interpreted with some caution given the methodological limitations identified.

Practice: The authors did not state any implications for practice.

Research: The authors stated that more research should focus on physical health and on clarifying the connections between mental well-being and physical health. They advised that future research should clarify the effects of family interventions compared with interventions solely for relatives. More research was needed with patients and relatives from different cultural groups, including female patients and their male relatives, older adults and ethnic minorities. Intervention studies should test a variety of activities for relatives.

The Danish Heart Foundation and Denmark's Ministry of the Interior and Health.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.