Importance Return to work is an important indicator of recovery after acute myocardial infarction. Little is known, however, about the rate of returning to work within the year after an acute myocardial infarction in China, as well as the factors associated with returning to work after an acute myocardial infarction. Objectives To determine the rate of return to work within 12 months after acute myocardial infarction, classify the reasons why patients did not return to work, and identify patient factors associated with returning to work. Design, Setting, and Participants This prospective cohort study, conducted in 53 hospitals across 21 provinces in China, identified 1566 patients who were employed at the time of the index acute myocardial infarction hospitalization and participating in the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction. Data collected included patients’ baseline characteristics; employment status at 12 months after acute myocardial infarction; and, for those who were not employed at 12 months, potential reasons for not returning to work. A logistic regression model was fitted to identify factors associated with returning to work at 12 months. Data were collected from January 1, 2013, through July 17, 2014, and statistical analysis was conducted from August 9, 2016, to August 15, 2018. Main Outcomes and Measures Return to work, defined as rejoining the workforce within 12 months after discharge from hospitalization for the index acute myocardial infarction. Results Of 1566 patients (130 women and 1436 men; mean [SD] age, 52.2 [9.7] years), 875 patients (55.9%; 95% CI, 53.4%-58.3%) returned to work by 12 months after acute myocardial infarction. Among the 691 patients who did not return to work, 287 (41.5%) were unable to work and/or preferred not to work because of acute myocardial infarction and 131 (19.0%) retired early owing to the acute myocardial infarction. Female sex (relative risk, 0.65; 95% CI, 0.41-0.88), a history of smoking (relative risk, 0.82; 95% CI, 0.65-0.98), and in-hospital complications during the index acute myocardial infarction (relative risk, 0.96; 95% CI, 0.93-0.99) were associated with a lower likelihood of returning to work. Conclusions and Relevance Almost half of the previously employed Chinese patients did not return to work within 12 months after acute myocardial infarction. Female sex, history of smoking, and in-hospital complications were associated with a lower likelihood of returning to work. Trial Registration ClinicalTrials.gov Identifier: NCT01624909

Key Points Question What are the risk factors associated with major cardiovascular events within 1 year among patients who survive an acute myocardial infarction? Findings In this cohort study of 4227 patients with acute myocardial infarction, 19 risk factors associated with major cardiovascular events 1 year after acute myocardial infarction, comprising 15 unique variables, were identified. A risk model to predict 1-year cardiovascular events after an acute myocardial infarction was developed and evaluated based on these risk factors. Meaning Identification of individuals at the highest risk of long-term cardiovascular events after acute myocardial infarction may aid in the provision of targeted, intensive, and higher-quality longitudinal care following discharge.

Background Secondary prevention after acute myocardial infarction ( AMI ) requires long‐term guideline‐directed medical therapy. However, the level of medication adherence, factors associated with poor adherence, and extent to which good adherence can reduce adverse events after AMI in China remain uncertain. Methods and Results In 2013 to 2014, 4001 AMI patients aged ≥18 years were discharged alive from 53 hospitals across China (mean age 60.5±11.7 years; 22.7% female). Good adherence was defined as taking medications (aspirin, β‐blockers, statins, clopidogrel, or angiotensin‐converting enzyme inhibitors/angiotensin‐receptor blockers) ≥90% of the time as prescribed. Cox models assessed the association between good adherence (a time‐varying covariate) and 1‐year cardiovascular events after AMI . The most common medications were aspirin (82.2%) and statins (80.5%). There were 243 patients who were not prescribed any medications during follow‐up; 1‐year event rates were higher for these patients (25.1%, 95% CI 19.7–30.6%) versus those taking ≥1 medications (6.6%, 95% CI 5.76–7.34%). The overall rate of good adherence was 52.9%. Good adherence was associated with lower risk of 1‐year events (adjusted hazard ratio 0.61, 95% CI 0.49–0.77). The most common reason for poor adherence was belief that one's condition had improved/no longer required medication. More comorbidities and lower education level were associated with poor adherence. Conclusions Good adherence reduced 1‐year cardiovascular event risk after AMI . About half of our cohort did not have good adherence. National efforts to improve AMI outcomes in China should focus on medication adherence and educating patients on the importance of cardiovascular medications for reducing risk of recurrent events. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01624909.