COPENHAGEN, DENMARK — Almost all employed individuals who had a first MI returned to work, but a year later, one in four was out of the workforce and receiving social benefits, a national registry study from Denmark shows[1].
The youngest and oldest patients and those with lower socioeconomic status were most likely to have dropped out of the workforce.
These new insights can be used to provide more focused rehab after an MI, the researchers say.
Previous reports have documented that up to nine out of 10 patients return to work after an MI, but now this study adds that “a considerable number” of patients who go back to work don’t stay employed, Dr Laerke Smedegaard (Copenhagen University, Denmark) told theheart.org | Medscape Cardiology.
Thus, “a patient’s return to work should not be a stop post [or end point] for post-MI cardiac rehabilitation,” she said. Rather, what’s required is “increased focus on maintenance of employment for those who return to work.”
Commenting for theheart.org | Medscape Cardiology on these findings, Dr Clyde W Yancy (Northwestern University, Chicago) agreed.
“These data argue for a more deliberate inclusion of ’employability’ in cardiac-rehab programs,” he said. Clinicians should ask patients about their employment and focus on “more overt inclusion of discussions about future employability in standard cardiac-rehab programs.”
In the US, with fewer healthcare and social benefits than Denmark, even more patients would likely return to work after an MI, Yancy speculated, “if only to keep health-insurance benefits intact.” Many more may leave work, perhaps feeling they need to find a less stressful job.
The study also highlights that “while rehabilitation strategies generally focus on elderly and vulnerable cases, younger and more resourceful patients (eg, patients who are employed) may not be invited or may decline or drop out from such programs,” Smedegaard and colleagues note.
“Our novel findings . . . suggest that a rehabilitation strategy with focus on employment maintenance is warranted,” they summarize, “in particular for patients aged 30 to 39 years and those of lower socioeconomic status who showed a disconcerting trend for becoming detached from employment.”
Their findings were published online October 4, 2017 in the Journal of the American Heart Association.
For this study, Smedegaard and colleagues aimed to better understand return to work after MI and especially to determine whether patients stay employed, by analyzing national Danish registry data.
They identified 39,296 patients who were 30 to 65 years old (working age) when they were discharged from the hospital after a first MI between 1997 and 2012. Of these, 22,394 (57%) had been employed when they were admitted to the hospital.
The patients had a mean age of 55, and most (81%) were men. About half (49%) were 50 to 59 years old; a quarter (25%) were 60 to 65 years old; 23% were 40 to 49 years old; and 4% were 30 to 39 years old.
Close to three-quarters (72%) had undergone coronary angiography, more than half (55%) had had PCI, and a few (6%) had had CABG.
The most common comorbidities were diabetes (9%), heart failure (9%), and arrhythmia (7%).
The researchers matched each MI patient with five controls in the general population with the same age and sex.
Within 1 month of hospital discharge, 42% of the MI patients had returned to work, and by 1 year, 91% had done so.
However, by 1 year after that return to work, 1% had died and 24% were no longer working; instead, they were receiving sick leave (11%), unemployment (6%), early retirement (5%), or pension (2%) benefits. Significantly fewer of the control patients were receiving these benefits (P<0.001 for all).
The MI patients were three times more likely to have stopped working, compared with the population controls.
“Alarming” Finding
MI patients who were 60 to 65, followed by patients age 30 to 39, were most likely to have stopped working.
It is not clear why the young patients would leave the workforce, but other studies have reported that young MI patients were more likely to have a poor lifestyle (smoke, have a high BMI), and perhaps employers may be less flexible with junior employees.
This finding is “alarming” since these individuals would potentially have many more years of productive work ahead of them, and unemployment is tied to higher rates of depression and lower quality of life, the researchers note.
The adjusted odds ratios (OR) of stopping work were higher in patients with MI who also had chronic kidney disease (OR 2.04), depression (OR 1.77), heart failure (OR 1.20), type 2 diabetes (OR 1.13), lower education levels, or lower income levels.
These results “are likely to be even more significant in countries with more societal and economic inequalities,” the researchers note.
Thus, “when evaluating a heart-attack patient’s quality of life and functional capacity, simply returning to work after a heart attack isn’t enough,” Smedegaard said in a statement. “Our findings suggest that cardiac rehabilitation after a heart attack should also focus on helping people maintain their ability to work in the long term for those who return to work.”
The study was supported by the Danish Agency for Science, Technology ,and Innovation; the Danish Council for Strategic Research, Helsefonden; and the Danish Heart Foundation. Smedegaard is supported by the Danish Agency for Science, Technology, and Innovation; the Danish Council for Strategic Research, Helsefonden; and the Danish Heart Foundation. Disclosures for the coauthors are listed in the paper.
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