Work-related outcome after acute coronary syndrome: Implications of complex cardiac rehabilitation in occupational medicine

Abstract

Objectives: Coronary heart disease is frequent in the working-age population. Traditional outcomes, such as mortality and hospital readmission, are useful for evaluating prognosis. Fit-for-work is an emerging outcome with clinical as well as socioeconomic significance. We describe the possible benefit of a cardiac rehabilitation (CR) program for return to work (RTW) after acute coronary syndrome (ACS). Material and Methods: We evaluated 204 patients with recent ACS. They were divided into 4 groups on the basis of their occupational work load: very light (VL), light (L), moderate (M), and heavy (H). Work-related outcomes were assessed with the Work Performance Scale (WPS) of the Functional Status Questionnaire and as "days missed from work" (DMW) in the previous 4 weeks. The variables considered for outcomes were percent ejection fraction, functional capacity expressed in metabolic equivalents (METs), and participation or non-participation in the CR program (CR+ and CR-). Results: One hundred thirty (66%) patients took part in the CR program. Total WPS scores for CR+ and CR-subgroups were VL group: 18±4 vs. 14±4 (p < 0.001), L group: 18±3 vs. 14±3 (p < 0.0001), M group: 19±3 vs. 16±3 (p < 0.003), and H group: 20±4 vs. 17±3 (p < 0.006). Fewer DMW were reported by the CR+ group. Conclusions: Non-participation in CR was a consistent cause of poorer work-related outcomes. Our findings indicate that CR and occupational counseling play a very important role in worker recovery and subsequent reintegration in the workplace, in particular among clerical workers. resistance training, and aerobic exercise. The education and counseling session (four 50-min counseling sessions for 1 month) consisted of advice on healthy nutrition, physical activity, maintaining a healthy body weight, and issues related to quitting smoking and alcohol consumption. Exclusion criteria were age > 65 years, severe concomitant non-cardiac diseases such as cancer, renal dysfunction (serum creatinine > 3 mg/dl), liver dysfunction (alanine aminotransferase/aspartate aminotransferase > 1.5 times the upper normal limit), and dementia, any systemic disease limiting exercise, and inability to participate in a prospective study for logistical reasons. The average energy requirement for the patients' work activities was estimated with the aid of pre-existing, specific tables [13] that classify the various tasks on the basis of metabolic equivalents (METs): < 3 METs -very INTRODUCTIONCoronary heart disease (CHD) is the main cause of death worldwide, accounting for 31% of mortality [1]. In fact, in the working population (aged < 65), CHD is the single most important cause of death in men, and in women it is preceded only by breast cancer [2][3]. It is both a medical and a socio-economic problem. Returning to work after a coronary event produces economic benefits for the community and patients alike, improving the quality of life of their families too [4][5]. It is generally recognized that the return to work is not a simple function of clinical status...

Health-related quality of life and associated factors in patients with myocardial infarction after returning to work: a cross-sectional study

“…According to this study, after returning to work, the body function, physical role and general health of patients were well recovered due to efficient treatments and rehabilitation via alleviation of symptoms [11]. Also, patients may choose suitable work to adapt to their physical functions to keep safety [12]. However, social function, mental health and emotional role of these patients were unsatisfactory.…”

“…All these factors make the quality of life an important outcome measure for patients with MI after returning to work. Surely, maintaining a good HRQoL after returning to work is crucial for patients to cope with work pressure [12] and to coordinate the conflict between work and treatment [13]. Taking this into account, to help MI patients return to society and strength long-term social functions, a successful and effective treatment of MI should not only focus on prolonging the lifetime, but also pay attention to the HRQoL of patients after returning to work [14].…”

Health-related quality of life and associated factors in patients with myocardial infarction after returning to work: a cross-sectional study

“…According to this study, after returning to work, the body function, physical role and general health of patients were well recovered due to efficient treatments and rehabilitation via alleviation of symptoms (11). Also, patients may choose suitable work to adapt to their physical functions and safety (12). However, social function, mental health and emotional role of these patients were unsatisfactory.…”

“…All these factors make the quality of life an important outcome measure for patients with MI after returning to work. Surely, maintaining a good HRQoL after returning to work is crucial for patients to cope with work pressure (12) and to coordinate the conflict between work and treatment(13). Taking this into account, to help MI patients return to society and strength long-term social functions, a successful and effective treatment of MI should not only focus on prolonging the lifetime, but also pay attention to the HRQoL of patients after returning to work (14).…”

Health-related quality of life and associated factors in patients with myocardial infarction after returning to work: a cross-sectional study

“…All of these factors make the quality of life an important outcome measure for patients with MI after returning to work. Surely, maintaining a good HRQoL after returning to work is critically important for patients to cope with work pressure (12) and to coordinate the conflict between work and treatment (13). Taking this into account to help MI patients truly return to society and strength long-term social functions, a successful and effective treatment of MI should not only focus on prolonging the lifetime, but also paying attention to the HRQoL of patients after returning to work (14).…”