- •A cohort of 401 patients <65 years of age after acute coronary syndrome or coronary artery bypass grafting was investigated.
- •Sixty-four percent of patients were gainfully employed 6 months after cardiac rehabilitation.
- •Depression and subjective occupational prognosis predicted return to work.
To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis.
Observational, prospective, bicentric.
Postacute 3-week inpatient cardiac rehabilitation (CR).
Patients (N=401) <65 years of age (mean 54.5±6.3y), 80% men.
Main Outcome Measures
Status of return to work (RTW) 6 months after discharge from CR.
The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect.
The patient’s perception and expectation regarding the occupational prognosis play a crucial role in predicting return to work 6 months after an acute cardiac event and CR. These findings highlight the importance of the multimodal approach, in particular psychosocial components, of CR.
List of abbreviations:ACS (acute coronary syndrome), CABG (coronary artery bypass grafting), CR (cardiac rehabilitation), MET (metabolic equivalent of the task), MoCA (Montreal Cognition Assessment), RTW (return to work)
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- Rehab report. The medical and vocational rehabilitation of the pension insurance in the light of statistics [German].German pension insurance, Berlin: Dt2018
- Psychological and clinical predictors of return to work after acute coronary syndrome.Eur Heart J. 2007; 28: 160-165
- Impact of gender, co-morbidity and social factors on labour market affiliation after first admission for acute coronary syndrome. A cohort study of Danish patients 2001-2009.PLoS One. 2014; 9: e86758
- The presence of a depressive episode predicts lower return to work rate after myocardial infarction.Gen Hosp Psychiatry. 2014; 36: 363-367
- Return to work after percutaneous coronary intervention: the predictive value of self-reported health compared to clinical measures.PLoS One. 2012; 7: e49268
- Resumption of work after acute coronary syndrome or coronary artery bypass graft surgery.Heart Lung Circ. 2014; 23: 444-453
- Impact of cognitive performance on disease-related knowledge six months after multi-component rehabilitation in patients after an acute cardiac event.Eur J Prev Cardiol. 2019; 26: 45-55
- The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005; 53: 695-699
- Habitual physical activity and health.WHO, Geneva, Switzerland1978
- Quality of life and return to work 5 years after coronary artery bypass surgery. Long-term results of cardiac rehabilitation.J Cardiopulm Rehabil. 1997; 17: 29-36
- Depression as a predictor of work resumption following myocardial infarction (MI): a review of recent research evidence.Health Qual Life Outcomes. 2010; 8: 95
Published online: May 01, 2019
Supported by the German Federal Pension Insurance (Deutsche Rentenversicherung Bund, grant no. 0421/00-40-64-50-39).
Clinical Trial Registration No.: DRKS00005502.
© 2019 by the American Congress of Rehabilitation Medicine