Predicting return to work after acute myocardial infarction: Socio-occupational factors overcome clinical conditions

Abstract

ObjectivesReturn to work after acute myocardial infarction (AMI), a leading cause of death globally, is a multidimensional process influenced by clinical, psychological, social and occupational factors, the single impact of which, however, is still not well defined. The objective of this study was to investigate these 4 factors on return to work (RTW) within 365 days after AMI in a homogeneous cohort of patients who had undergone an urgent coronary angioplasty.ParticipantsWe studied 102 patients, in employment at the time of AMI (88.24% of men), admitted to the Department of Cardiology of the University-Hospital of Ferrara between March 2015 to December 2016. Demographical and clinical characteristics were obtained from the cardiological records. After completing an interview on social and occupational variables and the Hospital Anxiety and Depression (HADS) questionnaire, patients underwent exercise capacity measurement and spirometry.ResultsOf the 102 patients, only 12 (12.76%) held a university degree, 68.63% were employees and 31.37% self-employed. The median number of sick-leave days was 44 (IQR 33–88). At day 30, 78.5% of all subjects had not returned to work, at day 60, 40.8% and at day 365 only 7.3% had not resumed working. At univariate analyses, educational degree (p = 0.026), self-employment status (p = 0.0005), white collar professional category (p = 0.020) and HADS depression score were significant for earlier return to work. The multivariate analysis confirms that having a university degree, being self-employed and presenting a lower value of HADS depression score increase the probability of a quicker return to work.ConclusionsThese findings suggest that the strongest predictors of returning to work within 1 year after discharge for an acute myocardial infarction are related more to socio-occupational than to clinical parameters.

Employment status three years after percutaneous coronary intervention and predictors for being employed: A nationwide prospective cohort study

“…This is consistent with previous findings showing a beneficial association between educational level and living with a partner with return to work. [16][17][18]20 Regarding gender differences, what we observed was consistent with the majority of previous findings, suggesting that women have lower rates of returning to work and longer sickness absences than men. 17,20,22 Dreyer et al and Cauter et al, however, did not find gender differences in their study after adjustment for other characteristics.…”

“…15 In previous international studies of employed patients, 86-93% of the patients were found to have returned to work one year after acute MI. [16][17][18][19] However, detachment is present; in a Danish nationwide registerbased study almost a quarter of MI patients reported to quit working one year after they successfully returned to work. 17 This demonstrates the importance of long-term follow-up when measuring return-to-work rates after cardiovascular revascularization.…”

The role of cardiac rehabilitation in vocational reintegration Belgian working group of cardiovascular prevention and rehabilitation position paper

“…Furthermore, the association between anxiety and RTW diminished after controlling for depression, further indicating the major role of depression [15]. Similarly, a recent observational study [16] concluded that lower selfreported depression scores were predictive of early RTW. Psychological co-morbidities were stronger predictors of RTW, when compared to disease-related factors.…”

The correlation of patientsʼ anxiety after a liver or kidney transplantation with functional and self-reported work ability

“…Stendardo et al found that a lower value of depression score increase the probability of a quicker return to work in patients after acute myocardial infarction. [ 25 ] Van der Kemp et al showed that depressive symptoms were associated with return to work after mild-to-moderate stroke. [ 26 ]…”