Psychological and Vocational Long-Term Outcomes of Cardiac Rehabilitation with Postinfarction Patients under the Age of Forty

Abstract

70 male postinfarction patients, who were under 40 years of age at the time of transmural myocardial infarction, participated in an inpatient control examination 3.8 years following first hospitalization (mean age: 40 years, SD = 3.5 years). A multivessel disease occurred in 52% of the patients, in 80% a multilocular disease was diagnosed and in 25 % coronary angiography indicated a progression in coronary sclerosis. Coronary risk factors had been considerably reduced. 78% were capable of working. Job-related stress factors of at least moderate intensity were present in about 30% of the jobs now held by the patients. Progressive morphological change occurred in patients who are older, have a multilocular disease, are subjected to more frequent and more intensive job-related stress factors, show less concern for their health and tend to leave their old living habits unchanged. In patients with multivessel disease, time pressure elicited more psychophysiological activation; furthermore, doing too many tasks at the same time and a reduced control over vocational success, together with sufficient self-confidence and an exaggerated job devotion are found in these patients. Retired patients differ from those who went back to work in cardiological, psychological and psychophysiological aspects. The importance of psychological and psychophysiological findings for a successful vocational reintegration is emphasized by these results.

Job Strain and Cardiovascular Disease

“…One study of men who had suffered an MI before age 40 indicated by coronary angiograms more progression of coronary atherosclerosis over five years in those with low job decision latitude than in others (74). However, another study of men who had suffered an MI before age 45, did not support this hypothesis (88).…”