Highlights
- •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.
Abstract
Objectives
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.
Design
Observational, prospective, bicentric.
Setting
Postacute 3-week inpatient cardiac rehabilitation (CR).
Participants
Patients (N=401) <65 years of age (mean 54.5±6.3y), 80% men.
Interventions
Not applicable.
Main Outcome Measures
Status of return to work (RTW) 6 months after discharge from CR.
Results
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.
Conclusions
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)Keywords
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Article info
Publication history
Published online: May 01, 2019
Footnotes
Disclosures: none.
Supported by the German Federal Pension Insurance (Deutsche Rentenversicherung Bund, grant no. 0421/00-40-64-50-39).
Clinical Trial Registration No.: DRKS00005502.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
