<p>The contribution of behavioural and psychosocial factors (such as lifestyle behaviours, negative emotions and social connection) to incident cardiovascular disease and cardiovascular events is well recognized, and interventions to reduce the risk associated with these factors have been proved effective. Yet the implementation of these interventions in clinical settings has been slow, at best. In this Perspective, we review the literature to identify the elements and actions needed for a broad adoption of behavioural medicine interventions in routine cardiovascular care. We specifically discuss the need for a behavioural medicine clinical trials enterprise that is more pragmatic in approach, utilizing implementation science methods and extant clinical data sources, and prioritizing patient-reported and quality-of-life outcomes, along with offsets in cost of care. We furthermore discuss the need for the development and testing of integrated care models, engaging with institutional stakeholders, patients and families, and healthcare systems.</p>