Return to work after myocardial infarction/coronary artery bypass grafting: patients' and physicians' initial viewpoints and outcome 12 months later

Adaptation and validation of the cardiovascular version of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES-CVD) to the Italian context

PURPOSE

Effective cardiac rehabilitation interventions must provide adequate support to overcome psychosocial return-to-work (RTW) barriers. No validated instrument is available for this aim for cardiovascular patients. The Return-to-work Obstacles and Self-Efficacy Scale (ROSES) measures RTW obstacles workers perceive and the self-efficacy for overcoming them through 46 items and ten dimensions. This study aimed to adapt and validate ROSES for cardiovascular disease (CVD) in the Italian context.

METHODS

This prospective study involved 183 CVD working patients at baseline and 121 six months later. ROSES-CVD internal consistency, construct, and predictive validity was evaluated with Cronbach's α, Confirmatory factor analyses (CFA), and ANCOVAs.

RESULTS

CFAs adequately replicated the original ROSES model (CFI = .92-.96; TLI = .91-.94; RMSEA = .042-.057; SRMR = .046-.071) with α close or higher than .70 for all dimensions. Four ROSES-CVD dimensions significantly predicted the number of days to RTW controlling for age, gender, educational level, and surgery type. Workers who perceived salient RTW obstacles and low self-efficacy in any of these dimensions in mean returned to work from 38 to 53 days later.

CONCLUSIONS

The study supported the validity and reliability of ROSES-CVD. This tool can be used in rehabilitation to detect CVD patients at risk of a longer RTW process and define appropriate cardiac rehabilitation intervention.IMPLICATIONS FOR REHABILITATIONVocational rehabilitation interventions should provide tailor-made support to overcome RTW barriers based on individual risk assessmentThe Italian translation of ROSES-CVD is a valid and reliable tool to measure psychosocial barriers to RTW among CVD working patientsThe use of ROSES-CVD would allow detection of CVD patients at risk of longer RTW processAdministering ROSES-CVD can help focus traditional vocational intervention on individually relevant obstacles to RTW.

Prevalence and determinants of return to work after various coronary events: meta-analysis of prospective studies

Return to work (RTW) after a coronary event remains a major concern. This systematic review and meta-analysis of prospective studies published between January 1988 and August 2020, aim to evaluate the prevalence of RTW after a coronary event (myocardial infarction, acute coronary syndrome, angina pectoris) and to assess the determinants of RTW (such as follow-up duration, date of recruitment, country, gender, occupational factors, etc.). PRISMA and MOOSE guidelines were followed. Study quality was assessed using the Newcastle–Ottawa Scale. Random-effects models were carried out to determine pooled prevalence estimates and 95% confident interval. A total of 43 prospective studies (34,964 patients) were investigated. RTW overall random effects pooled prevalence was estimated at 81.1% [95% CI 75.8–85.8]. Country, year of implementation or gender did not significantly modify the prevalence estimates. Lower level of education and degraded left ventricular ejection fraction decreased RTW prevalence estimates (respectively, 76.1% vs 85.6% and 65.3% vs 77.8%). RTW prevalence estimates were higher for white-collars (81.2% vs 65.0% for blue-collars) and people with low physical workload (78.3% vs 64.1% for elevated physical workload).Occupational physical constraints seem to have a negative role in RTW while psycho-logical factors at work are insufficiently investigated. A better understanding of the real-life working conditions influencing RTW would be useful to maintain coronary patients in the labor market.

Return to work after coronary artery bypass grafting and aortic valve replacement surgery: A scoping review

BACKGROUND

Coronary artery bypass grafting surgery and aortic valve replacement surgery are essential treatment options for people suffering from angina pectoris or aortic valve disease. Surgery aims to prolong life expectancy, improve quality of life, and facilitate participation in society for the individuals afflicted. The aim of this review was to explore the literature on work participation in patients following coronary artery bypass grafting or aortic valve replacement surgery, and to identify demographic and clinical characteristics associated with returning to work.

METHODS

A scoping review framework of Arksey and O'Malley was chosen. Four electronic databases: Medline, CINAHL, Embase, and Google Scholar were searched for studies in English, Swedish, Danish or Norwegian between January 1988 and January 2020. A blinded selection of articles was performed. The data were then charted and summarized by descriptive numerical analyses and categorized into themes.

RESULTS

Forty-five out of 432 articles were included in the final full-text analysis. Absence from work following coronary artery bypass graft grafting or aortic valve replacement surgery lasted on average 30 weeks, whereas 34% of the patients never returned to work. Being female, suffering from pre-existing depression, having limited secondary education, or low income were associated with decreased return to work rates. Previous employment was a decisive factor for returning to work after surgery. Data on return to work after aortic valve replacement were scarce.

CONCLUSIONS

A significant number of patients never return to work following coronary artery bypass grafting or aortic valve surgery, and the time interval until work return is longer than expected. Failure to resume work represents a threat to the patients' finances and quality of life. Nurses are in a unique position to assess work-related issues and have an active part in the multi-disciplinary facilitation of tailored occupational counselling after cardiac surgery.

High Job Burnout Predicts Low Heart Rate Variability in the Working Population after a First Episode of Acute Coronary Syndrome

(1) Background: Job burnout may affect the prognosis of patients with acute coronary syndrome (ACS) through mechanisms involving heart rate variability (HRV). However, no study has yet examined those potential associations. Hence, we conducted the present study to investigate this issue. (2) Method: Participants included patients who presented with a first episode of ACS and who were employed. The Copenhagen Burnout Inventory (CBI) was used to assess job burnout. Twenty-four-hour ambulatory electrocardiography recorded HRV on four occasions, i.e., during the hospitalization and follow-ups at one, six, and 12 months, respectively. (3) Results: A total of 120 participants who at least completed three Holter examinations throughout the study were enrolled in the final analysis. Job burnout scores at baseline were inversely associated with LnSDNN, LnTP, LnHF, LnLF, LnULF, and LnVLF during the consequent one-year follow-up. Each 1 SD increase in job burnout scores predicted a decline ranging from 0.10 to 0.47 in the parameters described above (all p < 0.05), and all relationships were independent of numerous confounders, including anxiety and depression. (4) Conclusion: High job burnout predicted reduced HRV parameters during the one-year period post-ACS in the working population.

Adverse Change in Employment Status After Acute Myocardial Infarction: Analysis From the TRANSLATE-ACS Study

BACKGROUND

Inability to resume employment after acute myocardial infarction (MI) has important implications for patients. We sought to assess the prevalence of and outcomes associated with adverse change in employment after MI in a national US cohort.

METHODS AND RESULTS

The TRANSLATE-ACS study (Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) assessed employment status at baseline and 1 year among 9319 patients with MI (mean age, 60.8 years; SD, 11.3; 27.3% women) enrolled at 233 US hospitals. We defined adverse change in employment as patients working at baseline but working less or not working at 1-year post-MI. In multivariable models, we assessed factors associated with adverse change in employment and its association with patient-reported depression, health status, persistence to evidence-based medications prescribed at discharge, and financial hardship affording medications. Half of the patients (51%; n=4730) were employed at the time of MI. By 1 year, 10% (n=492) of these reported an adverse change in employment, with 3% (n=143) working less and 7% (n=349) no longer working (only 27 of 349 reported retirement). Factors significantly associated with adverse change in employment included a number of unplanned readmissions, postdischarge bleeding complications, hypertension, and smoking. At 1 year, patients with an adverse change in employment were more likely to report depression (Patient Health Questionnaire 2 score >3: 27.4% versus 16.7%), lower health status (mean EuroQoL visual analogue scale: 73 [SD, 17.8] versus 78 [SD, 14.8]), and moderate-extreme financial hardship with medication costs (41.0% versus 28.4%; all P<0.001). There was no difference in persistence to evidence-based medications prescribed at discharge.

CONCLUSIONS

Patients who experienced an adverse change in employment after MI reported lower quality of life, increased depression, and more difficulty affording medications. These results underscore the need for interventions to address this patient-centered outcome and its health impact.

CLINICAL TRIAL REGISTRATION

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503.

Predicting return to work after acute myocardial infarction: Socio-occupational factors overcome clinical conditions

Objectives

Return to work after acute myocardial infarction (AMI), a leading cause of death globally, is a multidimensional process influenced by clinical, psychological, social and occupational factors, the single impact of which, however, is still not well defined. The objective of this study was to investigate these 4 factors on return to work (RTW) within 365 days after AMI in a homogeneous cohort of patients who had undergone an urgent coronary angioplasty.

Participants

We studied 102 patients, in employment at the time of AMI (88.24% of men), admitted to the Department of Cardiology of the University-Hospital of Ferrara between March 2015 to December 2016. Demographical and clinical characteristics were obtained from the cardiological records. After completing an interview on social and occupational variables and the Hospital Anxiety and Depression (HADS) questionnaire, patients underwent exercise capacity measurement and spirometry.

Results

Of the 102 patients, only 12 (12.76%) held a university degree, 68.63% were employees and 31.37% self-employed. The median number of sick-leave days was 44 (IQR 33–88). At day 30, 78.5% of all subjects had not returned to work, at day 60, 40.8% and at day 365 only 7.3% had not resumed working. At univariate analyses, educational degree (p = 0.026), self-employment status (p = 0.0005), white collar professional category (p = 0.020) and HADS depression score were significant for earlier return to work. The multivariate analysis confirms that having a university degree, being self-employed and presenting a lower value of HADS depression score increase the probability of a quicker return to work.

Conclusions

These findings suggest that the strongest predictors of returning to work within 1 year after discharge for an acute myocardial infarction are related more to socio-occupational than to clinical parameters.

Factors Associated With Return to Work After Acute Myocardial Infarction in China

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.

Predicting return to work following a cardiac event in Malaysia

BACKGROUND

Return to work is an important aspect for cardiac rehabilitation following a major cardiac event.

OBJECTIVE

The aim was to understand the local prevalence and factors associated with returning to work in Malaysia after a cardiac event.

METHODS

A cross sectional design was used. All patients attending the cardiac rehabilitation program after major cardiac event during an 11-months period (2011-2012) were included. Data relating to socio-demographic, work-related, risk factors and acute myocardial infarction were collected. The SF-36 questionnaire was used to assess quality of life. Regression analysis was used to determine the predicting factors to return to work.

RESULTS

A total of 398 files were screened, 112 respondents agreed to participate giving a response rate of 47.3%. The prevalence of returned to work (RTW) was 66.1% [95% CI: 57.2-75.0]. Factors associated with work resumption were age (Adj. OR: 0.92 (95% CI: 0.84-0.99), diabetes mellitus (Adj. OR: 3.70, 95% CI: 1.35-10.12), Mental Component Summary (MCS) score (Adj. OR: 1.05 (95% CI: 1.01-1.09) and baseline angiography findings. Patients with single vessel and two vessel disease were 8.9 times and 3.78 times more likely to return to work compared to those with 3 vessels (Adj. OR: 8.90 (95% CI: 2.29-34.64) and Adj. OR: 3.78, (95% CI: 1.12, 12.74).

CONCLUSIONS

We proposed a cardiac rehabilitation program to emphasize mental health as it may improve successful return to work after cardiac event.

Return to Work and Risk of Subsequent Detachment From Employment After Myocardial Infarction: Insights From Danish Nationwide Registries

Background

Limited data are available on return to work and subsequent detachment from employment after admission for myocardial infarction (MI).

Methods and Results

Using individual‐level linkage of data from nationwide registries, we identified patients of working age (30–65 years) discharged after first‐time MI in the period 1997 to 2012, who were employed before admission. To assess the cumulative incidence of return to work and detachment from employment, the Aalen Johansen estimator was used. Incidences were compared with population controls matched on age and sex. Logistic regression was applied to estimate odds ratios for associations between detachment from employment and age, sex, comorbidities, income, and education level. Of 39 296 patients of working age discharged after first‐time MI, 22 394 (56.9%) were employed before admission. Within 1 year 91.1% (95% confidence interval [CI], 90.7%–91.5%) of subjects had returned to work, but 1 year after their return 24.2% (95% CI, 23.6%–24.8%) were detached from employment and received social benefits. Detachment rates were highest in patients aged 60 to 65 and 30 to 39 years, and significantly higher in patients with MI compared with population controls. Predictors of detachment were heart failure (odds ratio 1.20 [95% CI, 1.08–1.34]), diabetes mellitus (odds ratio 1.13 [95% CI, 1.01–1.25]), and depression (odds ratio 1.77 [95% CI, 1.55–2.01]). High education level and high income favored continued employment.

Conclusions

Despite that most patients returned to work after first‐time MI, about 1 in 4 was detached from employment after 1 year. Several factors including age and lower socioeconomic status were associated with risk of detachment from employment.

Effectiveness of Medical Rehabilitation on Return-to-Work Depends on the Interplay of Occupation Characteristics and Disease

Introduction Work disability causes high costs for economy, organizations, and employees. However, medical rehabilitation does not always enable employees to return to their old jobs. In the present study, we investigated how disease classification and work characteristics interact in predicting the success of medical rehabilitation in terms of one's ability to return to a former job. Methods To this end, we matched 2009 patient data from the German Statutory Pension Insurance agency with job characteristics data from the Occupational Information Network (O*NET) 17.0 database. We used a multilevel approach and a sample of N = 72,029, nested in 194 occupational groups. Results We found that workers are less likely to reenter a former job if mental illnesses coincide with emotionally demanding labor and if musculoskeletal diseases coincide with extreme environmental conditions. We did not find different effects between occupational groups for other types of diseases (circulatory system, neoplasms, injuries, others). Conclusion Thus, the contextual overlap of disease and occupational characteristics notably lowers the chances of a successful return-to-work. These findings should be taken into account by physicians when attempting to set realistic goals for rehabilitation in collaboration with the patient and the funding agency.

Return to work after coronary revascularization procedures and a patient's job satisfaction: A prospective study

INTRODUCTION

Research into work reintegration following invasive cardiac procedures is limited. The aim of this prospective study was to explore predictors of job satisfaction among cardiac patients who have returned to work after cardiac rehabilitation (CR).

MATERIAL AND METHODS

The study population consisted of 90 cardiac patients who have recently been treated with coronary angioplasty or heart surgery. They were evaluated during their CR and 12 months after the discharge using validated self-report questionnaires measuring job satisfaction, work stress-related factors, emotional distress and illness perception. Information on socio-demographic, medical and occupational factors has also been collected.

RESULTS

After adjusting for demographic, occupational and medical variables, baseline job satisfaction (p < 0.001), depression (p < 0.01) and ambition (p < 0.05) turned out to be independent, significant predictors of job satisfaction following return to work (RTW). Patients who had a partial RTW were more satisfied with their job than those who had a full RTW, controlling for baseline job satisfaction.

CONCLUSIONS

These findings recommend an early assessment of patients' psychosocial work environment and emotional distress, with particular emphasis on job satisfaction and depressive symptoms, in order to promote satisfying and healthy RTW after cardiac interventions.

Using Animation to Improve Recovery from Acute Coronary Syndrome: A Randomized Trial

Background: Recovery from myocardial infarction has been associated with patients' perceptions of damage to their heart. New technologies offer a way to show patients animations that may foster more accurate perceptions and encourage medication adherence, increased exercise and faster return to activities.

PURPOSE

The purpose of this study was to investigate the effects of a brief animated intervention delivered at the patients' bedside on perceptions and recovery in acute coronary syndrome patients.

METHODS

Seventy acute coronary syndrome patients were randomly assigned to the intervention or standard care alone. Illness perceptions, medication beliefs and recovery outcomes were measured.

RESULTS

Post-intervention, the intervention group had significantly increased treatment control perceptions and decreased medication harm beliefs and concerns. Seven weeks later, intervention participants had significantly increased treatment control and timeline beliefs, decreased symptoms, lower cardiac avoidance, greater exercise and faster return to normal activities compared to control patients.

CONCLUSIONS

A brief animated intervention may be clinically effective for acute coronary syndrome patients (Trial-ID: ACTRN12614000440628).

Employment Status and Participation in Cardiac Rehabilitation: DOES ENCOURAGING EARLIER ENROLLMENT IMPROVE ATTENDANCE?

PURPOSE

For patients hospitalized for a cardiac event, an earlier appointment to outpatient cardiac rehabilitation (CR) increases participation. However, it is unknown what effect hastening CR enrollment might have among employed patients planning to return to work (RTW).

METHODS

Using 2 complementary data sets from Henry Ford Hospital (HFH) and Mayo Clinic, we assessed when employed patients eligible for CR anticipated a RTW, the impact of an earlier appointment on CR enrollment, and the effect of employment status on the number of CR sessions attended. Patients at HFH attended CR at either 8 or 42 days (through randomization), whereas Mayo Clinic patients attended 10 days after hospital discharge per standard routines.

RESULTS

Among 148 patients at HFH, 65 (44%) were employed and planned to RTW. Of these, 67% desired to RTW within 1 to 2 weeks, whereas 28% anticipated an RTW within 1 to 3 days. Home financial strain predicted nonparticipation in CR (P < .001) and was associated with an earlier planned RTW. Among 1030 patients at Mayo Clinic, 393 (38%) were employed. Employed (vs nonemployed) patients enrolled in CR 3.3 days sooner (P < .001), but attended 1.6 fewer CR sessions (P = .04). In employed patients from both health systems, an earlier (vs later) appointment to CR did not result in additional exercise sessions of CR.

CONCLUSIONS

Employed patients plan to RTW quickly, in part because of home finances. They also enroll earlier into CR than nonemployed patients. Despite these findings, earlier appointments do not seem to favorably impact overall CR participation.

Cardiac rehabilitation in Germany

The purpose of this review is to give an overview of the rehabilitation measures provided for cardiac patients in Germany and to outline its legal basis and outcomes. In Germany the cardiac rehabilitation system is different from rehabilitation measures in other European countries. Cardiac rehabilitation in Germany since 1885 is based on specific laws and the regulations of insurance providers. Cardiac rehabilitation has predominantly been offered as an inpatient service, but has recently been complemented by outpatient services. A general agreement on the different indications for offering these two services has yet to be reached. Cardiac rehabilitation is mainly offered after an acute cardiac event and bypass surgery. It is also indicated in severe heart failure and special cases of percutaneous coronary intervention. Most patients are men (>65%) and the age at which events occur is increasing. The benefits obtained during the 3-4 weeks after an acute event, and confirmed in numerous studies, are often later lost under 'usual care' conditions. Many attempts have been made by rehabilitation institutions to improve this deficit by providing intensive aftercare. One instrument set up to achieve this is the nationwide institution currently comprising more than 6000 heart groups with approximately 120000 outpatients. After coronary artery bypass grafting or acute coronary syndrome cardiac rehabilitation can usually be started within 10 days. The multidisciplinary rehabilitation team consists of cardiologists, psychologists, exercise therapists, social workers, nutritionists and nurses. The positive effects of cardiac rehabilitation are also important economically, for example, for the improvement of secondary prevention and vocational integration.

A Guided Workbook Intervention (WorkPlan) to Support Work-Related Goals Among Cancer Survivors: Protocol of a Feasibility Randomized Controlled Trial

Background

Returning to and staying at work following illness is associated with better physical and psychological functioning. Not working has been shown to be associated with reduced self-esteem, lowered self-efficacy, and decreased belief in one's ability to return to the workplace. Although there is a growing body of research looking at what predicts return to work following cancer treatment, there are fewer studies examining interventions targeting return to work.

Objective

The primary objective is to assess the feasibility and acceptability of a theoretically led workbook intervention designed to support cancer patients in returning to work to inform a fully powered randomized controlled trial (RCT).

Methods

This is a multicenter feasibility RCT where the main analysis uses a qualitative approach. Sixty participants (aged 18-65 years) who have received a diagnosis of cancer and who intend to return to work will be randomized to either the WorkPlan intervention group or a usual care group (ratio 1:1). Participants in the intervention group will receive a guided workbook intervention (which contains activities aimed at eliciting thoughts and beliefs, identifying targets and actions, and concrete steps to achieve goals) and will receive telephone support over a 4-week period. The primary outcome measure is time taken to return to work (in days), and secondary outcome measures include mood, quality of life, illness perceptions, and job satisfaction. Data will be collected through postal questionnaires administered immediately postintervention and at 6- and 12-month follow-ups. In addition, interviews will be undertaken immediately postintervention (to explore acceptability of the intervention and materials) and at 12-month follow-up (to explore perceptions of participation in the trial and experiences of returning to work).

Results

Enrollment for the study will be completed in May 2016. Data analysis will commence in April 2017, and the first results are expected to be submitted for publication in late 2017.

Conclusions

Currently no standardized return-to-work intervention based on targeting cancer patient beliefs is in existence. If the intervention is shown to be feasible and acceptable, the results of this study will inform a future full RCT with the potential to provide a valuable and cost-efficient tool in supporting cancer survivors in the return-to-work process.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN56342476; http://www.isrctn.com/ISRCTN56342476 (Archived by WebCite at http://www.webcitation.org/6gblhEPXd).

Effect of Psychosocial Work Environment on Sickness Absence Among Patients Treated for Ischemic Heart Disease

INTRODUCTION

During the last decades mortality has declined in patients with coronary heart disease due to improvements in treatments and changes in life style, resulting in more people living with chronic heart disease. This implies that focus on rehabilitation and re-integration to the work-force becomes increasingly important. Previous studies among healthy workers suggest that the psychosocial working environment is associated with sickness absence. Whether the psychosocial working environment plays a role for patients with existing cardiovascular disease on return to work and sickness absence is less studied.

METHODS

A cohort of patients under 67 years and treated with percutaneous coronary intervention (PCI) was established in 2006. Three months after the procedure the patients (n = 625) answered a questionnaire about their psychosocial working environment. Patients were followed in registers for the following year. We examined the association between psychosocial working environment and sickness absence at 3 months, 1 year and new sick-listings during the first year with logistic regression.

RESULTS

A total of 528 patients had returned to work 3 months after the PCI, while 97 was still sick-listed. After 1 year one was dead, 465 were working and 85 were receiving health related benefits, while 74 had left the workforce permanently. A number of 106 patients were sick-listed during the whole first year or had left the workforce permanently. After the initial return to work, 90 experienced a new sickness absence during the first year while the remaining 429 did not. High work pace, low commitment to the workplace, low recognition (rewards) and low job control were associated with sickness absence at 3 months, but not after 1 year. Low job control as well as job strain (combination of high demands and low control) was associated with new sick-listings.

CONCLUSION

The psychosocial working environment was associated with sickness absence 3 months after the PCI, but not 1 year after.

Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation

BACKGROUND

Return to work (RTW) is a pivotal goal of cardiac rehabilitation (CR) in patients after acute cardiac event. We aimed to evaluate cardiopulmonary exercise testing (CPX) parameters as predictors for RTW at discharge after CR.

METHODS

We analyzed data from a registry of 489 working-age patients (51.5 ± 6.9 years, 87.9 % men) who had undergone inpatient CR predominantly after percutaneous coronary intervention (PCI 62.6 %), coronary artery bypass graft (CABG 17.2 %), or heart valve replacement (9.0 %). Sociodemographic and clinical parameters, noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and psychodiagnostic screening data, as well as CPX findings, were merged with RTW data from the German statutory pension insurance program and analyzed for prognostic ability.

RESULTS

During a mean follow-up of 26.5 ± 11.9 months, 373 (76.3 %) patients returned to work, 116 (23.7 %) did not, and 60 (12.3 %) retired. After adjustment for covariates, elective CABG (HR 0.68, 95 % CI 0.47-0.98; p = 0.036) and work intensity (per level HR 0.83, 95 % CI 0.73-0.93; p = 0.002) were negatively associated with the probability of RTW. Exercise capacity in CPX (in Watts) and the VE/VCO2-slope had independent prognostic significance for RTW. A higher work load increased (HR 1.17, 95 % CI 1.02-1.35; p = 0.028) the probability of RTW, while a higher VE/VCO2 slope decreased (HR 0.85, 95 % CI 0.76-0.96; p = 0.009) it. CPX also had prognostic value for retirement: the likelihood of retirement decreased with increasing exercise capacity (HR 0.50, 95 % CI 0.30-0.82; p = 0.006).

CONCLUSION

CPX is a valid tool for assessing patients' ability to return to work. Therefore, it may be an essential part of functional assessment during CR for predicting participation in employment.

The importance, measurement and practical implications of worker's expectations for return to work

PURPOSE

Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.

METHOD

A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.

RESULTS

A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.

CONCLUSIONS

Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns. Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.

Impact of gender, co-morbidity and social factors on labour market affiliation after first admission for acute coronary syndrome. A cohort study of Danish patients 2001-2009

Background

Over the last decades survival after acute coronary syndrome (ACS) has improved, leading to an increasing number of patients returning to work, but little is known about factors that may influence their labour market affiliation. This study examines the impact of gender, co-morbidity and socio-economic position on subsequent labour market affiliation and transition between various social services in patients admitted for the first time with ACS.

Methods

From 2001 to 2009 all first-time hospitalisations for ACS were identified in the Danish National Patient Registry (n = 79,714). For this population, data on sick leave, unemployment and retirement were obtained from an administrative register covering all citizens. The 21,926 patients, aged 18–63 years, who had survived 30 days and were part of the workforce at the time of diagnosis were included in the analyses where subsequent transition between the above labour market states was examined using Kaplan-Meier estimates and Cox proportional hazards models.

Findings

A total of 37% of patients were in work 30 days after first ACS diagnosis, while 55% were on sick leave and 8% were unemployed. Seventy-nine per cent returned to work once during follow-up. This probability was highest among males, those below 50 years, living with a partner, the highest educated, with higher occupations, having specific events (NSTEMI, and percutaneous coronary intervention) and with no co-morbidity. During five years follow-up, 43% retired due to disability or voluntary early pension. Female gender, low education, basic occupation, co-morbidity and having a severer event (invasive procedures) and receiving sickness benefits or being unemployed 30 days after admission were associated with increased probability of early retirement.

Conclusion

About half of patients with first-time ACS stay in or return to work shortly after the event. Women, the socially disadvantaged, those with presumed severer events and co-morbidity have lower rates of return.

Work-related predictors of not returning to work after inpatient rehabilitation in cancer patients

BACKGROUND

The purpose of the study was to explore the association between work-related factors and not returning to work in cancer patients. The identification of any special issues contributes to the development of occupation-related rehabilitation programmes. This study focused on aspects that may be influenced by patients with the help of counselling (e.g., handling occupational stress).

MATERIAL AND METHODS

At the beginning and one year after the end of rehabilitation, we asked patients to answer occupation-related questionnaires. We used t-tests and χ(2)-tests as well as logistic regression analyses to address our research questions.

RESULTS

Of 333 patients, 21% had not returned to work one year after the end of rehabilitation. In comparison with working patients, patients who were not working reported poorer mental health and more occupational problems at the beginning of rehabilitation. Unemployment at the beginning of rehabilitation, an elevated risk of early retirement and limited self-assessed work ability increased the probability of not returning to work.

CONCLUSION

Patients who did not return to work represent a subgroup within rehabilitation. These patients need special support and should receive counselling beyond the time of rehabilitation. This is particularly true for unemployed patients who need intensive help to return to the workforce. Furthermore, patients' estimations of their work ability and their plans for returning to work play a crucial role and should be discussed during rehabilitation.

Return to work after coronary artery bypass in patients aged under 50 years

Background: This study was designed to identify factors associated with return to work and quality of life in patients undergoing primary coronary artery bypass at age <50 years.

Methods: 172 patients <50-years old underwent primary coronary artery bypass between January 2000 and December 2006. Predictors of return to work were analysed from variables in a prospectively collected database and on follow-up by the SF-36 questionnaire in 129 (75%) patients.

Results: 136 (79%) patients were working prior to surgery. The educational level was: primary 14.5%, secondary 47%, trade 22%, tertiary 13%, and postgraduate 3%. Type of occupation was blue collar 51%, white collar 41%, pensioner 27%, and unspecfied 8%. The mean follow-up was 86.4 ± 23.4 months. One hundred and twenty-six (69%) patients attended cardiac rehabilitation. Forty (23%) patients experienced recurrence of symptoms; 11 (6%) required reintervention. One hundred and twenty-seven (93%) patients returned to work postoperatively. Univariate predictors of return to work were male sex, blue-collar work, and working prior to surgery. Independent predictors of return to work were working prior to surgery and blue-collar work. Patients who returned to work had significantly higher scores in all 8 domains on the SF36-Questionnaire compared to those who did not return to work.

Conclusions: Preoperative employment and blue collar occupation were associated with a higher rate of return to work after coronary artery bypass in patients of working age. Patients who returned to work had significantly better measured quality of life than those who did not.

Perceived learning needs of Yemeni patients after coronary artery bypass graft surgery

AIMS AND OBJECTIVES

  To explore the information needs of Yemeni patients who have undergone coronary artery bypass graft surgery before hospital discharges and to examine the differences in the patients' learning needs according to age, gender, level of education and working condition.

BACKGROUND

Postcoronary artery bypass graft (CABG) patients need more information before their discharge from the hospital. This need of information must be assessed and provided for them before their discharge from hospital to help them with adequate care and recovery at home. Design.  A descriptive, correlational design.

METHODS

Data were collected from 120 CABG patients before their discharge from Al- Thawra Hospital, Sana'a, Yemen, by using modified Cardiac Patients Learning Needs Inventory (CPLNI) instrument. The Statistical Package for the Social Sciences was used to analyse the collected data.

RESULTS

The information about chest and leg wound care, medication information, other pertinent information and complications were indicated to be the most valued by CABG patients prior to discharge. There was a statistically significant difference between patients' total learning needs according to their socio-demographic characteristics. Male patients needed more information than female patients (p=0.004). Younger (p=0.021) and middle-aged (p=0.032) patients needed more information than older ones. Highly educated (p=0.000) and school-level (p=0.002) patients needed more information than those in the uneducated group. Working patients needed more information than non-working ones (p=0.000).

CONCLUSION

This study suggests that CABG patients have high information needs within 24-48 hours before hospital discharge. In addition, the results of this study showed that there are statistically significant differences in patients' learning needs according to their demographic characteristics.

RELEVANCE TO CLINICAL PRACTICE

Assessment of CABG patients' information needs before their discharge from hospital helps in developing effective educational programme that will help these patients in their recovery at home.

Does job satisfaction predict early return to work after coronary angioplasty or cardiac surgery?

PURPOSE

Few studies have analyzed the relationship between job satisfaction and return to work (RTW) in cardiac patients. The aim of this paper was to investigate whether job satisfaction predicted early RTW in patients sick listed after cardiac invasive procedures.

METHODS

A 6-month prospective study was carried out in a sample of 83 patients in working age who had recently been treated with angioplasty or cardiac surgery. Job satisfaction was measured using the scale from the Occupational Stress Indicator during cardiac rehabilitation. Time to RTW was assessed at the 6-month occupational physician examination. Logistic regression analyses were used to study the association between job satisfaction at baseline and early RTW at follow-up, adjusted for socio-demographic, medical (type of cardiac intervention, ejection fraction) and psychological (depression, locus of control, illness perception) factors.

RESULTS

Participants with high job satisfaction were more likely to return early to work, with an odds ratio (OR) of 5.92 (95 % CI, 1.69-20.73) in the most-adjusted model, compared to participants with low job satisfaction. Satisfaction with organizational processes was the job satisfaction component most strongly associated with early RTW (OR, 4.30; 95 % CI, 1.21-15.03).

CONCLUSIONS

To the best of our knowledge, this is the first prospective study that investigated whether job satisfaction predicts time to RTW after cardiac interventions. The results suggested that when patients are satisfied with their job and positively perceived their work environment, they will be more likely to early RTW, independently of socio-demographic, medical and psychological factors.

Work reintegration and cardiovascular disease: medical and rehabilitation influences

INTRODUCTION

Research into work reintegration following cardiovascular disease onset is limited in its clinical and individual focus. There is no research examining worker experience in context during the return to work process.

METHODS

Qualitative case study method informed by applied ethnography. Worker experience was assessed through longitudinal in-depth interviews with 12 workers returning to work following disabling cardiac illness. Workplace context (Canadian auto manufacturing plant) was assessed through site visits and meetings with stakeholders including occupational health personnel. Data was analyzed using constant comparison and progressive coding.

RESULTS

Twelve men (43-63 years) participated in the study. Results revealed that unyielding production demands and performance monitoring pushed worker capacities and caused "insidious stress". Medical reassurance was important in the workers' decisions to return to work and stay on the job but medical restrictions were viewed as having limited relevance owing to limited understanding of work demands. Medical sanction was important for transient absence from the workplace as well as permanent disability. Cardiac rehabilitation programs were beneficial for lifestyle modification and building exercise capacity, but had limited benefit on work reintegration. Occupational health provided monitoring and support during work reintegration.

CONCLUSIONS

Medical reassurance can be an important influence on worker representations of disease threat. Medical advice as it pertained to work activities was less valued as it lacked considerations of work conditions. Cardiac rehabilitation lacked intensity and relevance to work demands. Occupational health was reassuring for workers and played an important role in developing return to work plans.

The impact of gender on early ill-health retirement in people with heart disease and depression

OBJECTIVE

Depression and heart disease are major causes of early ill-health retirement. The effect of comorbid depression on the award of ill-health retirement in those with heart disease is unclear, however, and may differ by gender. Given the deleterious effects of ill-health retirement, identifying at-risk groups is important for guiding targeted interventions.

METHOD

We retrospectively analysed baseline data of 20,655 participants from the 45 and Up Study (New South Wales, Australia), who had fully retired between the ages of 45 and 64. We examined the associations of depression and heart disease with ill-health retirement and then adjusted for the presence of common confounders. We then restricted the sample to the 1165 individuals with heart disease prior to retirement, to determine the impact of comorbid depression on IHR and analysed whether there was a differential impact by gender.

RESULTS

In the complete sample, 3836 out of 20,655 (18.6%) of the participants retired early due to ill health. Prior heart disease and depression were both independently and strongly associated with ill-health retirement. Those who retired due to ill health were also more likely to be men, less educated, report greater physical disability and were younger at retirement. Among the 1165 for whom heart disease predated any form of retirement, 40% retired due to ill health. Comorbid depression prior to ill-health retirement was strongly associated with an increased risk of this IHR in women (odds ratio = 2.85; 95% confidence interval = 1.20-6.77, p = 0.01), but not in men (interaction term, p = 0.045).

CONCLUSIONS

Ill-health retirement is common in those with heart disease. Women appear to be particularly susceptible to the effects of comorbid depression. Given the policy emphasis on reducing the number of people leaving the workforce early, women with early heart disease may represent a particular group in whom interventions designed to detect and treat comorbid depression should be targeted.

Coronary patients who returned to work had stronger internal locus of control beliefs than those who did not return to work

OBJECTIVES

Return To Work (RTW) is an important indicator of recovery from coronary artery disease (CAD), associated with social and economical benefits, and improved quality of life. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are effective procedures relieving symptoms and reducing the risk for new events, but psychosocial problems are frequent among these patients. The aim was to determine psychosocial and treatment-related factors associated with RTW among PCI and CABG patients in Northern Norway.

DESIGN

Cross-sectional design based on questionnaire data from CABG and PCI patients 3-15 months following discharge, and from hospital records.

METHODS

Of the 348 responding patients, 168 were younger than 67 years and working prior to hospitalization. Factors associated with RTW were examined in a logistic regression analysis.

RESULTS

A total of 108 (64%) had RTW within 3-15 months. Four factors made unique significant contributions to the model, including higher education, time since hospital discharge and Internal Locus of Control (LoC) of the Multidimensional Health Locus of Control Scale (MHLC) as positively associated factors, and Powerful Others LoC as a negatively associated factor. Analyses controlled for data on demographics, emergency status, type of treatment, number of days at the hospital, physical exercise, attending a rehabilitation program, mental distress, Type D personality, and for the CABG patients additional data on coronary health.

CONCLUSIONS

Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed.

Examining the Matthew effect on the motivation and ability to stay at work after heart disease

AIMS

Cardiac rehabilitation should safeguard that socioeconomic factors or other differences that affect people's cardiovascular health are not further aggravated after healthcare treatment. The study examines whether socioeconomic status, emotional problems, or the severity of disease affect people's ability to continue to work after heart disease. We also examined if these effects can be explained by differences in motivational factors.

METHODS

217 patients (41 women) from the Krokeide Rehabilitation Centre in Bergen participated. Multiple linear regression analysis was used to examine motivational differences, and logistic regression analysis was used to examine whether socioeconomic factors or other differences affected people's ability to continue to work after heart disease.

RESULTS

Self-efficacy for future work strongly impacted the likelihood of being incapacitated for work during the 2-year follow-up. The household's total income and emotional problems were statistically significant related to patients dropping out from work in the course of the observation. The association between emotional problems and future work was mediated by motivational problems. The relation between income and future incapacity for work could not be explained by motivational factors.

CONCLUSIONS

The study shows a clear Matthew effect on people's ability to continue to work after heart disease as low-income groups and people with emotional problems are more at risk of dropping out of work. This Matthew effect was, however, only explained by the motivational difficulties for the association between emotional distress and dropping out of work and not for the impact of household income on the likelihood of leaving work.

Return to work after coronary artery bypass surgery. A 10-year follow-up study

OBJECTIVES

To establish which factors influence patients' return to work and how well they remain at work after coronary artery bypass grafting (CABG).

DESIGN

Five hundred and sixty nine consecutive CABG patients aged less than 65 years were followed for 10 years. Data were collected from patient records and by questionnaires supplemented with information from Finnish national archives.

RESULTS

Multivariate analysis showed the best predictors for return to work to be younger age, preoperative working, as well as absence of diabetes or perioperative cardiac damage. Almost half of the patients aged less than 60 and preoperatively not retired were working one year after CABG. Five years postoperatively, 85% of patients younger than 60 years and once returned to work were still working. Correspondingly, of subjects remaining under 60 years during a 10-year follow-up, 75% continued working.

CONCLUSIONS

Younger age and preoperative employment were the most important predictors of successful return to work. Once returned after CABG, patients' staying at work was comparable with that in the general population.

Depression as a predictor of work resumption following myocardial infarction (MI): a review of recent research evidence

BACKGROUND

Depression often coexists with myocardial infarction (MI) and has been found to impede recovery through reduced functioning in key areas of life such as work. In an era of improved survival rates and extended working lives, we review whether depression remains a predictor of poorer work outcomes following MI by systematically reviewing literature from the past 15 years.

METHODS

Articles were identified using medical, health, occupational and social science databases, including PubMed, OVID, Medline, Proquest, CINAHL plus, CCOHS, SCOPUS, Web of Knowledge, and the following pre-determined criteria were applied: (i) collection of depression measures (as distinct from 'psychological distress') and work status at baseline, (ii) examination and statistical analysis of predictors of work outcomes, (iii) inclusion of cohorts with patients exhibiting symptoms consistent with Acute Coronary Syndrome (ACS), (iv) follow-up of work-specific and depression specific outcomes at minimum 6 months, (v) published in English over the past 15 years. Results from included articles were then evaluated for quality and analysed by comparing effect size.

RESULTS

Of the 12 articles meeting criteria, depression significantly predicted reduced likelihood of return to work (RTW) in the majority of studies (n = 7). Further, there was a trend suggesting that increased depression severity was associated with poorer RTW outcomes 6 to 12 months after a cardiac event. Other common significant predictors of RTW were age and patient perceptions of their illness and work performance.

CONCLUSION

Depression is a predictor of work resumption post-MI. As work is a major component of Quality of Life (QOL), this finding has clinical, social, public health and economic implications in the modern era. Targeted depression interventions could facilitate RTW post-MI.

Depression and occupational disability in five diagnostic groups: A review of recent research

PURPOSE

To compare the methodologies and results of research across five diagnostic groups in which there was expected to be a high prevalence of depression and occupational disability.

METHOD

A review of research published since 1994 was carried out concerning depression and occupational disability in five diagnostic groups: Major depressive disorder (MDD), spinal cord injuries (SCI), traumatic brain injuries (TBI), chronic back pain (CP) and myocardial infarction/coronary artery bypass grafting (MI/CABG).

RESULTS

Prospective longitudinal designs were mostly undertaken in MDD studies. Diagnostic interview schedules were utilized in most MDD studies whereas self-report inventories that tend to confound somatic and depressive symptoms were mostly used in CP, SCI, TBI and MI/CABG studies. In longitudinal MDD studies both depression and occupational disability were related to access to enhanced primary care treatment. On the other hand, CP research reported different results concerning the strength of depressive symptoms, cognitive and psychosocial factors in predicting occupational disability. Different trends across diagnostic groups were evident in relation to depression, occupational disability, co-morbidity, socio-demographic factors and psychosocial resources.

CONCLUSIONS

Co-morbid, socio-demographic and psychosocial factors provide a framework from which to identify those at greater risk of depression and occupational disability. However, more CP, SCI, TBI and MI/CABG studies with diagnostic schedules, prospective designs and longer follow-up are required.

Socioeconomic inequalities in the employment impact of ischaemic heart disease: a longitudinal record linkage study in Sweden

Aims: Low socioeconomic status is associated with increased risk of ischaemic heart disease (IHD) in many European and North American countries. We hypothesize that the adverse impact of having IHD may also be heavier in lower socioeconomic groups and may constitute a mechanism for generating or reinforcing social inequalities in health. Methods: Population registers of the 1.8 million residents of Stockholm County were used to assess the employment consequences over five years of having a diagnosis of IHD (600 cases) requiring hospital admission in 1996. We calculated annual age-standardized employment rates and age-adjusted odds of leaving employment during 1997—2001 by social class for in-patients and the general population. Results: Men and women who had an in-patient episode for IHD had lower age-standardized employment rates than the general population. Following hospital admission, the likelihood of patients with IHD leaving employment increased annually, and by 2001 their adjusted odds were almost four times greater (odds ratio 3.95, 95% confidence interval 3.23—4.83) than for the general population. The impact of IHD on employment was more severe with decreasing social class and patients employed in low-skilled manual occupations were significantly more likely to lose employment than professional workers with the same diagnosis. Within each social class patients had significantly higher odds of leaving employment than the general population. Conclusions: In spite of its progressive employment and rehabilitation policies, our study revealed considerable and socially differentiated employment consequences of IHD in Sweden. More account needs to be taken of such differential impact in health and social policy development.

Illness consequences after myocardial infarction: problems with physical functioning and return to work

AIM

This paper is a report of a study to explore health problems, physical and mental functioning, and physical activity in working-age patients after myocardial infarction, in order to assess the possible effects of these factors on return to work.

BACKGROUND

A diagnosis of myocardial infarction may discourage patients from continuing an active working life. Enabling myocardial infarction patients to return to work has benefits for both individuals and society.

METHODS

A convenience sample was recruited of 88 patients, <or=65 years of age, who had suffered a myocardial infarction. Assessments of employment, health-related quality of life and physical activity (footsteps per day) were conducted in 2005-2006, 4-6 months after myocardial infarction. To explore data and compare groups, t-tests were applied. Logistic regression analyses were performed to identify variables that best predicted return to work.

RESULTS

Differences were identified between individuals who were employed after myocardial infarction and those who were not. Those not in work scored lower on variables related to the physical dimension of health-related quality of life and on physical activity. Logistic regression revealed that a multivariate model including age, physical dimension of health-related quality of life and footsteps per day predicted return to work in 68% of all cases (R2=0.344).

CONCLUSION

Low physical health and low physical activity after myocardial infarction negatively affect returning to work. These findings stress the importance of clinical assessment of myocardial infarction patients' daily physical activity and physical functioning.

Work–Heart Balance

The complexities of managing heart failure among employees have not been studied. In this mixed methods study, the authors explored how cognition, physical functioning, attitudes, and self-efficacy influence self-care among employees with heart failure. Forty-one adults (White, 68.3%; male, 63.4%; median age, 51 years; employed, 48.8%) completed in-depth interviews and standardized instruments. Content analysis was used to derive themes from narrative accounts of self-care practices, attitudes, and self-efficacy within the context of employment. Descriptive and nonparametric statistics were used to describe the sample and generate hypotheses about relationships among the variables. Most of the employed participants ( N = 13) worked full-time (65%), primarily in sedentary jobs. Cognition and physical functioning were better in those who were employed ( p = .02), but self-care practices were lower ( p = .03). Those who successfully managed heart failure and work described strategies to incorporate self-care into their workdays, self-efficacy in managing symptoms while at work, and favorable attitudes toward employment.

Return to work after acute myocardial infarction--listen to your doctor!

Predictors of return to work after an acute myocardial infarction (AMI) are not fully established. In multivariate analysis adjusted for sex, age and type of intervention, only doctor's advice remained associated with return to work (HR 47.6, 95% CI 4.7-500). This suggests that doctor's advice is a comprehensive integration of patient interview, clinical examination, evidence based medicine and clinical experience, and thus the key predictor of return to work after AMI.

Long-term results of a three-week intensive cardiac out-patient rehabilitation program in motivated patients with low social status

The short-term benefits of cardiac rehabilitation (CR) are well established. In contrast, well-documented long-term results are rare. The objective of this longitudinal multi-centre observational study was to examine the effects of intensive out-patient CR in a larger patient cohort, especially for patients with low social status. We present the final results 24 months after CR.

METHODS

The study group of 327 patients (288 men, 39 women, aged 56.0+/-10.8 years, coronary artery disease in 295, other cardiac diseases in 32) participated in a 3- week CR programme followed by clinical re-evaluations 6 (III), 12 (IV) an 24 (V) months later.

RESULTS

The improvement in mean maximal performance of 100.5+/-31.4 to 123.1+/-36.2 W (p<0.01) achieved during CR was further improved to 128.7+/-40.9 W (p < 0,01) after 24 months. Of the patients, 61.2% reported regular physical activity during the 24 months of the study. The lipid management achieved by CR was maintained over 24 month. At I 65%, at II 84.4% and at V 82.4% of the patients with coronary artery disease (CAD) were undergoing lipid lowering therapy. BMI increased from 26.8+/-3.0 to 27.6+/-3.6 kg/m2 (p < 0.01) during follow-up. Of the patients, 23.2% were active smokers at V. Cardiovascular diagnosis remained unaltered in 74.3% of patients. The obtained results are interesting with respect to the social status of the patients since 68% were general laborers. The results confirm the long-term effectiveness of an intensive 3-week out-patient CR programme. Most of the benefits achieved by CR appear to be sustainable in this population for at least 2 years.

Physician-estimated disease severity in patients with chronic heart or lung disease: a cross-sectional analysis

BACKGROUND

We evaluated how well physicians' global estimates of disease severity correspond to more specific physician-rated disease variables as well as patients' self-rated health and other patient variables.

METHODS

We analyzed baseline data from 1662 primary care patients with chronic cardiac or pulmonary disease who were enrolled in a longitudinal study of health-related quality of life (HRQoL). Each patient's primary physician rated overall disease severity, estimated the two-year risk of hospitalization and mortality, and reported the use of disease-specific medications, tests, and subspecialty referrals. Patient variables included sociodemographic characteristics, psychosocial factors, self-rated health, and both generic and disease-specific HRQoL.

RESULTS

Physicians rated 40% of their patients "about average", 30% "worse", and 30% "better" than the typical patient seen with the specific target disorder. The physician's global estimate of disease severity was strongly associated (P < 0.001) with each of the five more specific elements of physician-rated disease severity, but only marginally associated with patient self-rated health. Multivariable regression identified a set of patient variables that explained 16.4% of the variance in physician-rated disease severity.

CONCLUSION

Physicians' global ratings may provide disease severity and prognostic information unique from and complementary to patient self-rated health and HRQoL measures. The elements influencing physician-rated disease severity and its predictive validity for clinical outcomes warrant prospective investigation.