Severe cardiomyopathy (SCM) imposes considerable psychosocial stress on families however, little is known about the effect of SCM from the point of view of the marital couple. In this study, adjustment to SCM of 90 patients and their spouses was compared. Patients reported more vocational, domestic, and sexual problems than spouses. Spouses reported more problems in health care orientation, family relationships, and psychological distress than patients. The findings indicate that severe cardiomyopathy impacts on the psychosocial integrity of both partners. Therefore, one should plan interventions to support spouses as well as patients. Because problems of spouses and patients may differ, both partners should be assessed to appropriately target interventions.