The importance of return to work: How to achieve optimal reintegration in ACS patients

Abstract

The vocational reintegration of patients after an acute coronary syndrome is a crucial step towards complete convalescence from the social as well as the individual point of view. Return to work rates are determined by medical parameters such as left ventricular function, residual ischaemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts and the ability to commute (which is, in part, determined by physical fitness). Psychosocial factors including depression, self-perceived health situation and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. A comprehensive healthcare pathway of acute coronary syndrome patients is initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients experiencing an acute coronary syndrome, and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action.

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

“…22,23 At the same time, they should emphasize the importance of return to work and reduce the risk of poor vocational outcomes. 24 Finally, the systematic evaluation of outcome parameters/goals at the end of the programme should now be considered as a real core component of modern cardiac rehabilitation interventions.…”

Standardization and quality improvement of secondary prevention through cardiovascular rehabilitation programmes in Europe: The avenue towards EAPC accreditation programme: A position statement of the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology (EAPC)

“…Use most recent evidence to achieve optimal reintegration of acute coronary syndrome patients on returning to work. 64 A social worker should be available to help resolving social and economical problems that affect transportation to the CR programme, consultations, examinations and also medication adherence, among others. Especially old, low-income and low-level education patients may benefit from this support.…”

Nicht pharmakologische Sekundärprävention und Rehabilitation: aktuelle Evidenz

“…Die medizinisch-beruflich orientierte Rehabilitation (MBOR) ist eine spezifische Form der medizinischen Rehabilitation, die insbesondere für Personen mit BBPL gezielt eine intensivierte Diagnostik anbietet und anschließend ein konkretes berufsbezogenes Konzept therapeutischer Maßnahmen erstellt. Um kardiovaskuläre Patienten hinsichtlich ihrer Arbeitsfähigkeit besser charakterisieren und sie in einem standardisierten Behandlungspfad bedarfsgerecht von den einzelnen Berufsgruppen (Sozialarbeiter, Haus-oder Betriebsärzte, Kardiologen, Psychologen) behandeln zu können, wurde von der Sektion Secondary Prevention and Rehabilitation der European Association of Preventive Cardiology (EAPC) eine entsprechende Übersichtsarbeit verfasst [29].…”