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Mortensen M, Nilsen RM, Kvalheim VL, Bjørnstad JL, Svendsen ØS, Haaverstad R, Moi AL. The influence of socio-demographic and clinical factors on sick leave and return to work after open-heart surgery: a nationwide registry-based cohort study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:431-445. [PMID: 37858302 PMCID: PMC11307200 DOI: 10.1093/ehjqcco/qcad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/27/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Abstract
AIMS To estimate sick leave (SL) duration after first-time elective open-heart surgery and identify factors contributing to increased SL. METHODS AND RESULTS A retrospective nationwide cohort study combined data from the Norwegian Register for Cardiac Surgery and SL data from the Norwegian Labour and Welfare Administrations. All able-bodied adults who underwent first-time elective open-heart surgery in Norway between 2012 and 2021 were followed until 1 year after surgery. The impact of socio-demographic and clinical factors on SL after surgery was analysed using logistic regression and odds ratios. Of 5456 patients, 1643 (30.1%), 1798 (33.0%), 971 (17.8%), 1035 (18.9%), and 9 (0.2%) had SL of <3, 3-6, 6-9, and 9-12 months, and 1 year, respectively. SL >6 months was associated with female gender, primary education only, and average annual income. Post-operative stroke, post-operative renal failure, New York Heart Association Functional Classification system (NYHA) score >3, earlier myocardial infarction, and diabetes mellitus increased the odds of SL >6 months. CONCLUSION This study demonstrates that socio-demographic and clinical factors impact SL after first-time elective open-heart surgery. Patients who experience a stroke or develop renal failure after surgery have the highest odds of SL >6 months. Females and patients with low education levels, earlier myocardial infarction, or NYHA scores III-IV have a two-fold chance of SL >6 months. The findings allow for future investigations of pre- and post-surgery interventions that can most effectively reduce SL and aid return to work.
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Affiliation(s)
- Michael Mortensen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O box 7030, 5020 Bergen, Norway
| | - Roy M Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Venny L Kvalheim
- Department of Cardiothoracic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Johannes L Bjørnstad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Norwegian Register for Cardiac Surgery, Oslo, Norway
| | - Øyvind S Svendsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Rune Haaverstad
- Department of Cardiothoracic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O box 7030, 5020 Bergen, Norway
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
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Emamzadehashemi KR, Khanghah AG, Azizi A, Paryad E, Noveiri MJS. Quality of life and activities of daily living one year after Coronary Artery Bypass Graft (CABG) surgery: a cross-sectional study. J Cardiothorac Surg 2024; 19:367. [PMID: 38915074 DOI: 10.1186/s13019-024-02848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Daily activities have been recommended to minimize the long-term complications of coronary artery bypass as one of the strategies to return to the normal activity level, the effectiveness of which needs further investigation. This study aims to determine the quality of life and activities of daily living one year after CABG. METHODS This cross-sectional study was performed on 206 patients who had undergone CABG for more than one year in 2018 in the north of Iran. The research instrument was a questionnaire including five sections, Data were analyzed using descriptive statistics and Chi2, Mann-Whitney U, Kruskal-Wallis tests, and a Logistic regression model. RESULT The mean score of quality of life was 31.7 ± 2.04 of 12 to 48 possible scores. About Activities of Daily Living results showed 99.5% and 84.7% of the samples needed help with many of these activities respectively. The mean score of quality of life was significantly different based on sex (p < 0.018) and instrumental activity of daily living (p < 0.0001). A logistic regression model was used to determine the factors related to quality of life. The final model showed cross-clamp duration (OR = 0.33,p = 0.014), length of stay(LOS)in the intensive care unit(OR = 0.42,p = 0.05), and instrumental activities of daily living (OR = 0.08,p = 0.001) predicted patients' quality of life one year after coronary artery bypass grafting. CONCLUSION Although more than half of the samples had a good average quality of life score, due to the lack of definitive treatment for coronary artery disease, it is suggested to consider predictive variables to help plan to improve the quality of life of these patients.
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Affiliation(s)
- Khashayar Rezvani Emamzadehashemi
- Department of Neurosurgery, Faculty of Medicine, Imam Khomeini Hospital, Urmia University of Medical Sciences, Guilan University of Medical Sciences, Rasht, Iran
| | - Atefeh Ghanbari Khanghah
- Social Determinants of Health Research Center (SCHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
- Nursing and Midwifery Faculty of Guilan University of Medical Sciences, Daneshjoo Ave, Rasht, Iran
| | - Ali Azizi
- School of Nursing and Midwifery, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Ezzat Paryad
- School of Nursing and Midwifery, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Cardiovascular Diseases Research Center, GI Cancer Screening and Prevention Research Center (GCSPRC), Department of Nursing (Medical-Surgical), Rasht, Iran
| | - Marzieh Jahani Sayad Noveiri
- Department of Medical Surgery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
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Mortensen M, Sandvik RKNM, Svendsen ØS, Haaverstad R, Moi AL. Return to work after coronary artery bypass grafting and aortic valve replacement surgery: A scoping review. Scand J Caring Sci 2021; 36:893-909. [PMID: 34057755 DOI: 10.1111/scs.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Michael Mortensen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Reidun K N M Sandvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Øyvind S Svendsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
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Rauch B, Salzwedel A, Bjarnason-Wehrens B, Albus C, Meng K, Schmid JP, Benzer W, Hackbusch M, Jensen K, Schwaab B, Altenberger J, Benjamin N, Bestehorn K, Bongarth C, Dörr G, Eichler S, Einwang HP, Falk J, Glatz J, Gielen S, Grilli M, Grünig E, Guha M, Hermann M, Hoberg E, Höfer S, Kaemmerer H, Ladwig KH, Mayer-Berger W, Metzendorf MI, Nebel R, Neidenbach RC, Niebauer J, Nixdorff U, Oberhoffer R, Reibis R, Reiss N, Saure D, Schlitt A, Völler H, von Känel R, Weinbrenner S, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1. J Clin Med 2021; 10:2192. [PMID: 34069561 PMCID: PMC8161282 DOI: 10.3390/jcm10102192] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. METHODS The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the "Association of the Scientific Medical Societies in Germany" (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. RESULTS Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on "treatment intensity" including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. CONCLUSIONS These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.
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Affiliation(s)
- Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, D-67063 Ludwigshafen, Germany
- Zentrum für Ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Birna Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, D-50937 Köln, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Karin Meng
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, D-97078 Würzburg, Germany;
| | | | | | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Bernhard Schwaab
- Curschmann Klinik Dr. Guth GmbH & Co KG, D-23669 Timmendorfer Strand, Germany;
| | | | - Nicola Benjamin
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Kurt Bestehorn
- Institut für Klinische Pharmakologie, Technische Universität Dresden, Fiedlerstraße 42, D-01307 Dresden, Germany;
| | - Christa Bongarth
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam-Sanssouci, D-14471 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Hans-Peter Einwang
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Johannes Falk
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany;
| | - Stephan Gielen
- Klinikum Lippe, Standort Detmold, D-32756 Detmold, Germany;
| | - Maurizio Grilli
- Universitätsbibliothek, Universitätsmedizin Mannheim, D-68167 Mannheim, Germany;
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Manju Guha
- Reha-Zentrum am Sendesaal, D-28329 Bremen, Germany;
| | - Matthias Hermann
- Klinik für Kardiologie, Universitätsspital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland;
| | - Eike Hoberg
- Wismarstraße 13, D-24226 Heikendorf, Germany;
| | - Stefan Höfer
- Universitätsklinik für Medizinische Psychologie und Psychotherapie, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria;
| | - Harald Kaemmerer
- Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Klinik der Technischen Universität München, D-80636 München, Germany;
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM) Langerstraße 3, D-81675 Munich, Germany;
| | - Wolfgang Mayer-Berger
- Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, D-42799 Leichlingen, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine University, Werdener Straße. 4, D-40227 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Medizinische Reha-Einrichtungen der Stadt Radolfzell, D-73851 Radolfzell, Germany;
| | - Rhoia Clara Neidenbach
- Institut für Sportwissenschaft, Universität Wien, Auf der Schmelz 6 (USZ I), AU-1150 Wien, Austria;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Uwe Nixdorff
- EPC GmbH, European Prevention Center, Medical Center Düsseldorf, D-40235 Düsseldorf, Germany;
| | - Renate Oberhoffer
- Lehrstuhl für Präventive Pädiatrie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, D-80992 München, Germany;
| | - Rona Reibis
- Kardiologische Gemeinschaftspraxis Am Park Sanssouci, D-14471 Potsdam, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, Ulmenallee 5-12, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Axel Schlitt
- Paracelsus Harz-Klinik Bad Suderode GmbH, D-06485 Quedlinburg, Germany;
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Roland von Känel
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich, CH-8091 Zürich, Switzerland;
| | - Susanne Weinbrenner
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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Reibis R, Salzwedel A, Abreu A, Corra U, Davos C, Doehner W, Doherty P, Frederix I, Hansen D, Christine Iliou M, Vigorito C, Völler H. The importance of return to work: How to achieve optimal reintegration in ACS patients. Eur J Prev Cardiol 2019; 26:1358-1369. [DOI: 10.1177/2047487319839263] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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.
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Affiliation(s)
- Rona Reibis
- Center of Rehabilitation Research, University of Potsdam, Germany
- Cardiac Outpatient Clinic Park Sanssouci, Potsdam, Germany
| | - Annett Salzwedel
- Center of Rehabilitation Research, University of Potsdam, Germany
| | - Ana Abreu
- Department of Cardiology, Hospital de Santa Marta, Portugal
| | - Ugo Corra
- Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, Italy
| | | | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
| | | | - Ines Frederix
- Faculty of Medicine and Life Sciences, Hasselt University, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | | | | | - Carlo Vigorito
- Internal Medicine and Cardiac Rehabilitation, University of Naples Federico II, Italy
| | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam, Germany
- Klinik am See, Rehabilitation Center for Internal Medicine, Germany
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Wang W, Lim JY, Lopez V, Wu VX, Lee CH, He HG, Jiang Y. The effect of a self-help psychoeducation programme for people with coronary heart disease: A randomized controlled trial. J Adv Nurs 2018; 74:2416-2426. [PMID: 29992600 DOI: 10.1111/jan.13793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/30/2018] [Accepted: 05/09/2018] [Indexed: 12/17/2022]
Abstract
AIM To examine the effect of a self-help psychoeducation program for people with coronary heart disease in Singapore. BACKGROUND Cardiac rehabilitation has shown benefits for mitigating many cardiac risk factors and can lead to improvement in health-related quality of life and psychological well-being in people with heart disease. However, traditional hospital-based cardiac rehabilitation faces substantial challenges. A self-management cardiac rehabilitation program offers an avenue to increase uptake and empowers patients to manage their condition at home. DESIGN A two-arm, randomized controlled trial. METHODS A total of 129 patients with coronary heart disease were recruited from an outpatient clinic in a public hospital in Singapore from April 2015-January 2016. They were randomly assigned to the intervention group or the control group. Participants in the intervention group received the 4-week home-based self-help psychoeducation program. Outcomes were measured at baseline and at 4 weeks and 16 weeks from the baseline. RESULTS There were no significant differences in health-related quality of life, psychological status (i.e., perceived stress level, anxiety, and depression levels), or cardiac physiological risk parameters between the intervention and the control groups immediately after the program or at different time points. There was also no significant difference in unplanned health service use at the 16 week posttest point between the two groups. CONCLUSIONS This study did not find any significant effect of our program on outpatients with coronary heart disease. Nonetheless, findings on participant characteristics may offer healthcare professionals valuable insights to help facilitate future development of an effective cardiac rehabilitation program catered to outpatients with coronary heart disease. TRIAL REGISTRATION The study has been registered with ISRCTN registry. The trial registration number is ISRCTN15839687.
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Affiliation(s)
- Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jian Yang Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chi-Hang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Benstoem C, Wübker R, Lüngen M, Breuer T, Marx G, Autschbach R, Goetzenich A, Schnoering H. [Sense of Coherence Scale according to Antonovsky as a possible predictor for return to work for cardiac surgery intensive care patients]. Anaesthesist 2018; 67:512-518. [PMID: 29761259 DOI: 10.1007/s00101-018-0448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND For cardiac surgery patients who were employed prior to surgery, the return to their professional life is of special importance. In addition to medical reasons, such as pre-existing conditions, the success of the operation or postoperative course and patient-intrinsic reasons, which can be assessed with the Sense of Coherence (SOC) scale by Antonovsky, may also play a role in the question of a possible return into working life. METHODS In this study 278 patients (invasive coronary artery bypass graft surgery and/or surgery on heart valves, age < 60 years, employed) were questioned postoperatively via post with the SOC questionnaire. The SOC questionnaire was used in addition to questions about return to work. The cohort was stratified according to the time of return to work. Subsequently, the point of maximum sensitivity and specificity was determined for the total SOC score and the prediction power was considered. RESULTS Of the 278 patients, 61 questionnaires (22%) were considered as eligible and included in the analysis. Of these, 47 participants had returned to work after undergoing cardiac surgery and 14 participants had not. We observed significant differences in SOC values between both groups (146.07 ± 29.76 versus 124.29 ± 28.8, p = 0.020). Patients that returned to work within the first 6 months after surgery showed even higher SOC scores (148.56 ± 28.98, p = 0.034). CONCLUSION Patients with an SOC score < 130 are at greater risk not to return to their professional life after cardiac surgery. The SOC is an easily obtainable score that reliably predicts the probability of return to work after cardiac surgery.
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Affiliation(s)
- C Benstoem
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät RWTH Aachen, Aachen, Deutschland.
| | - R Wübker
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Lüngen
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - T Breuer
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät RWTH Aachen, Aachen, Deutschland
| | - G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät RWTH Aachen, Aachen, Deutschland
| | - R Autschbach
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - A Goetzenich
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Schnoering
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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Reibis R, Kühl U, Salzwedel A, Rasawieh M, Eichler S, Wegscheider K, Völler H. Return to work in heart failure patients with suspected viral myocarditis. SAGE Open Med 2017; 5:2050312117744978. [PMID: 29276589 PMCID: PMC5734435 DOI: 10.1177/2050312117744978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/02/2017] [Indexed: 01/06/2023] Open
Abstract
Background: Endomyocardial biopsy is considered as the gold standard in patients with suspected myocarditis. We aimed to evaluate the impact of bioptic findings on prediction of successful return to work. Methods: In 1153 patients (48.9 ± 12.4 years, 66.2% male), who were hospitalized due to symptoms of left heart failure between 2005 and 2012, an endomyocardial biopsy was performed. Routine clinical and laboratory data, sociodemographic parameters, and noninvasive and invasive cardiac variables including endomyocardial biopsy were registered. Data were linked with return to work data from the German statutory pension insurance program and analyzed by Cox regression. Results: A total of 220 patients had a complete data set of hospital and insurance information. Three quarters of patients were virus-positive (54.2% parvovirus B19, other or mixed infection 16.7%). Mean invasive left ventricular ejection fraction was 47.1% ± 18.6% (left ventricular ejection fraction <45% in 46.3%). Return to work was achieved after a mean interval of 168.8 ± 347.7 days in 220 patients (after 6, 12, and 24 months in 61.3%, 72.2%, and 76.4%). In multivariate regression analysis, only age (per 10 years, hazard ratio, 1.27; 95% confidence interval, 1.10–1.46; p = 0.001) and left ventricular ejection fraction (per 5% increase, hazard ratio, 1.07; 95% confidence interval, 1.03–1.12; p = 0.002) were associated with increased, elevated work intensity (heavy vs light, congestive heart failure, 0.58; 95% confidence interval, 0.34–0.99; p < 0.049) with decreased probability of return to work. None of the endomyocardial biopsy–derived parameters was significantly associated with return to work in the total group as well as in the subgroup of patients with biopsy-proven myocarditis. Conclusion: Added to established predictors, bioptic data demonstrated no additional impact for return to work probability. Thus, socio-medical evaluation of patients with suspected myocarditis furthermore remains an individually oriented process based primarily on clinical and functional parameters.
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Affiliation(s)
- Rona Reibis
- Center for Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Uwe Kühl
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - Annett Salzwedel
- Center for Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Mortesa Rasawieh
- Klinik am See, Rehabilitation Center of Cardiovascular Disease, Ruedersdorf, Germany
| | - Sarah Eichler
- Center for Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heinz Völler
- Center for Rehabilitation Research, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Center of Cardiovascular Disease, Ruedersdorf, Germany
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Butt JH, Rørth R, Kragholm K, Kristensen SL, Torp-Pedersen C, Gislason GH, Køber L, Fosbøl EL. Return to the workforce following coronary artery bypass grafting: A Danish nationwide cohort study. Int J Cardiol 2017; 251:15-21. [PMID: 29079413 DOI: 10.1016/j.ijcard.2017.10.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/24/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Returning to the workforce after coronary artery bypass grafting (CABG) holds important socioeconomic consequences not only for patients, but the society as well. Yet data on this issue are limited. We examined return to the workforce and associated factors in patients of working age undergoing CABG. METHODS AND RESULTS Using Danish nationwide administrative registries, we identified 6031 patients of working age (18-60years) undergoing isolated CABG (1998-2011) who were part of the workforce 30days prior to admission and alive at discharge. One year after discharge for CABG, 4827 (80.0%) patients had returned to the workforce, 614 (10.2%) were on paid sick leave, 267 (4.4%) received disability pension, 250 (4.1%) were on early retirement, 57 (0.9%) had died, and 16 (0.3%) had emigrated. Factors associated with return to the workforce were identified using multivariable logistic regression. Younger age (18-45 versus 56-60years; odds ratio, 1.89; 95% confidence interval, 1.48-2.42), male sex (1.51, 1.24-1.84), and higher level of education (higher educational level versus basic school; 1.53, 1.05-2.23) and income (highest quartile versus lowest; 3.01, 2.42-3.75) were associated with return to the workforce. Urgency of surgery (emergency versus elective; 0.65, 0.49-0.88), cardiovascular comorbidity, a history of chronic kidney disease (0.49, 0.29-0.84) and liver disease (0.47, 0.28-0.80), as well as additional hospital admissions within the first year post-discharge (>2 versus none; 0.25, 0.19-0.32) were associated with a lower likelihood of returning to the workforce. CONCLUSION One year after discharge for CABG, four out of five patients were part of the workforce and mortality was low. Younger age, male sex, higher socioeconomic status, and absence of major comorbidities were associated with return to the workforce.
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Salzwedel A, Reibis R, Wegscheider K, Eichler S, Buhlert H, Kaminski S, Völler H. Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation. Clin Res Cardiol 2015; 105:257-67. [PMID: 26377430 DOI: 10.1007/s00392-015-0917-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/07/2015] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Annett Salzwedel
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany
| | - Rona Reibis
- Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Eichler
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany
| | - Hermann Buhlert
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
| | - Stefan Kaminski
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
| | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany.
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany.
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Work Status and Return to the Workforce after Coronary Artery Bypass Grafting and/or Heart Valve Surgery: A One-Year-Follow Up Study. Rehabil Res Pract 2014; 2014:631842. [PMID: 25024848 PMCID: PMC4082852 DOI: 10.1155/2014/631842] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 05/26/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Several characteristics appear to be important for estimating the likelihood of reentering the workforce after surgery. The aim of the present study was to describe work status in a two-year time period around the time of cardiac surgery and estimate the probability of returning to the workforce. Methods. We included 681 patients undergoing coronary artery bypass grafting and/or heart valve procedures from 2003 to 2007 in the North Denmark Region. We linked hospital data to data in the DREAM database which holds information of everyone receiving social benefits. Results. At the time of surgery 17.3% were allocated disability pension and 2.3% were allocated a permanent part-time benefit. Being unemployed one year before surgery reduced the likelihood of return to the workforce (RR = 0.74 (0.60-0.92)) whereas unemployment at the time of surgery had no impact on return to the workforce (RR = 0.96 (0.78-1.18)). Sickness absence before surgery reduced the likelihood of return to the workforce. Conclusion. This study found the work status before surgery to be associated with the likelihood of return to the workforce within one year after surgery. Before surgery one-fifth of the population either was allocated disability pension or received a permanent part-time benefit.
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Worcester MU, Elliott PC, Turner A, Pereira JJ, Murphy BM, Le Grande MR, Middleton KL, Navaratnam HS, Nguyen JK, Newman RW, Tatoulis J. Resumption of Work After Acute Coronary Syndrome or Coronary Artery Bypass Graft Surgery. Heart Lung Circ 2014; 23:444-53. [DOI: 10.1016/j.hlc.2013.10.093] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/04/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
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Osler M, Mårtensson S, Prescott E, Carlsen K. 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. PLoS One 2014; 9:e86758. [PMID: 24497976 PMCID: PMC3907569 DOI: 10.1371/journal.pone.0086758] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/13/2013] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Merete Osler
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Solvej Mårtensson
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
| | - Eva Prescott
- Department of Cardiology Y, Bispebjerg Hospital, Copenhagen, Denmark
| | - Kathrine Carlsen
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
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