Perceived return-to-work pressure following cardiovascular disease is associated with age, sex, and diagnosis: a nationwide combined survey- and register-based cohort study

Abstract

Background Return to work is a key rehabilitation goal for people with cardiovascular disease (CVD) because employment matters to individuals and societies. However, people recovering from CVD often struggle with returning to work and maintaining employment. To identify people in need of vocational counselling, we examined the probability of feeling under pressure to return to work following CVD. Methods We conducted a combined survey- and register-based study in a randomly selected, population-based cohort of 10,000 people diagnosed with atrial fibrillation, heart failure, heart valve disease, or ischaemic heart disease in 2018. The questionnaire covered return-to-work items, and we reported the probabilities of feeling under pressure to return to work with 95% confidence intervals (CIs) in categories defined by sex, age, and CVD diagnosis. Results The survey response rate was 51.1%. In this study, we included 842 respondents (79.7% men) aged 32–85 years, who had returned to work following a sick leave. Overall, 249 (29.7%) had felt pressure to return to work. The probability of feeling under pressure to return to work ranged from 18.3% (95% CI: 13.1–24.6) among men aged > 55 years with atrial fibrillation to 51.7% (95% CI: 32.5–70.6) among women aged ≤ 55 years with atrial fibrillation. In addition, 66.0% of all respondents had not been offered vocational rehabilitation, and 48.6% of those who reported a need for vocational counselling had unmet needs. Survey responses also indicated that many respondents had returned to work before feeling mentally and physically ready. Conclusion A substantial proportion of people with cardiovascular disease feel under pressure to return to work, and this pressure is associated with age, sex, and diagnosis. The results show that vocational rehabilitation must be improved and emphasize the importance of ensuring that cardiac rehabilitation programmes include all core rehabilitation components.

Barriers and facilitators to return to work following cardiovascular disease: a systematic review and meta-synthesis of qualitative research

“…Furthermore, some participants felt left alone with the responsibility of their own rehabilitation with lack of professional support. They similarly described an insufficient focus on re-employment in cardiac rehabilitation programmes, which mirror previous research, indicating that vocational rehabilitation is not adequately implemented within cardiac rehabilitation programmes19 42 43 and that most European countries lack clear guidelines for vocational rehabilitation 10. However, other researchers have documented that cardiac rehabilitation programmes hold potential in improving return to work,9 11 44 and our findings illustrate the value of including vocational rehabilitation within cardiac rehabilitation efforts.…”

“…This supports previous research showing that people with CVD often feel pressured to return to work due to financial reasons. 19 Similarly, as described by Hegewald et al , delayed return to work can have negative financial consequences on individuals, especially when adequate financial support is not provided and this may be the main reason to decide if, and when, to return. 9 …”

“… 13 14 17 In addition, many people with CVD feel pressured to return to work, 19 and face numerous barriers, including physical and psychological limitations, 15–17 comorbidities 12–15 17 and lack of support at the workplace or from cardiac rehabilitation programmes. 19 …”

“…Predictors of return to work have been explored in recent quantitative studies,10–18 and factors specifically associated with non-return to work include female gender,12–15 17 older age,12 13 15 17 lower educational level12–15 17 and low income 13 14 17. In addition, many people with CVD feel pressured to return to work,19 and face numerous barriers, including physical and psychological limitations,15–17 comorbidities12–15 17 and lack of support at the workplace or from cardiac rehabilitation programmes 19…”