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Bernt Jørgensen SM, Johnsen NF, Maribo T, Brøndum S, Gislason G, Kristiansen M. Factors shaping return to work: a qualitative study among heart failure patients in Denmark. Disabil Rehabil 2024; 46:4205-4215. [PMID: 37818938 DOI: 10.1080/09638288.2023.2266998] [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: 02/05/2023] [Revised: 09/30/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE For people of working-age diagnosed with heart failure, return to work (RTW) is often a significant rehabilitation goal. To inform vocational rehabilitation strategies, we conducted a qualitative study aiming at exploring patient experienced support needs, and barriers and facilitators to RTW. MATERIALS AND METHODS Ten men and eight women with heart failure (48-60 years) were interviewed in Denmark during 2022. A thematic analysis was conducted using the Sherbrooke model as framework. RESULTS Multiple factors operating at different levels shaped participants' RTW processes. Personal factors included motivation, mental and physical health, social relations, and financial concerns. Factors in the health care system shaping RTW included access to medical treatment, mental health care, and cardiac rehabilitation. Factors in workplace system shaping RTW included job type, employer support, and social relations. Factors in the legislative and insurance system shaping RTW included authorities' administration of sickness benefits, professional assistance, vocational counselling, and interdisciplinary cooperation. CONCLUSION Findings illustrate a need to include vocational rehabilitation within comprehensive cardiac rehabilitation programmes, to identify people in need of support, to improve the coordination of care across the health and social care sectors, and to involve employers, health care professionals, and social workers in individualised RTW strategies.
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Affiliation(s)
- Sidsel Marie Bernt Jørgensen
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Nina Føns Johnsen
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Central Denmark Region, DEFACTUM, Aarhus, Denmark
| | - Stig Brøndum
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
| | - Gunnar Gislason
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Bjerre HL, Mols RE, Bakos I, Frausing MHJP, Horváth-Puhó E, Witt CT, Eiskjær H, Løgstrup BB, Kronborg MB, Nielsen JC. Labor Market Participation Among Working-Age Heart Failure Patients With a Cardiac Resynchronization Therapy Device. J Cardiopulm Rehabil Prev 2024; 44:345-352. [PMID: 38985002 DOI: 10.1097/hcr.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE Labor market participation is an important rehabilitation goal for working-age patients living with heart failure (HF). Cardiac resynchronization therapy (CRT) reduces mortality and HF hospitalizations and improves quality of life, but no studies have investigated labor market participation following CRT. We therefore aimed to describe labor market participation in patients with HF before and after CRT implantation. METHODS This region-wide register-based cohort study comprised patients with HF aged 40 to 63 yr, with ejection fraction ≤35% and QRS duration >130 milliseconds, who received a CRT system from 2000 to 2017 in the Central Denmark Region. Using unambiguous, individual-level linkage in Danish medical and administrative registries, we assessed weekly employment status from 1 yr prior to CRT implantation until 2 to 5 yr of follow-up and conducted stratified analyses by sociodemographic and disease-related risk factors. RESULTS We identified 546 patients, of whom 42% were in early retirement 1 yr prior to implantation. Active employment decreased from 45% to 19% from 1 yr before until implantation, declining primarily in the last 8 wk before implantation. The proportion of patients in active employment increased in the first 8 wk after CRT implantation and then stabilized, reaching 31% at 1-yr follow-up. We observed lower labor market participation in patients with older age, multimorbidity, lower educational level, and upgrade procedures, but higher in later calendar year. CONCLUSIONS In working-age patients with HF, labor market participation increased after CRT implantation, despite many patients being retired prior to implantation. We observed differences in active employment related to several sociodemographic and disease-related factors.
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Affiliation(s)
- Henrik Laurits Bjerre
- Author Affiliations : Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (Drs Bjerre, Mols, Frausing, Eiskjær, Løgstrup, Kronborg, and Nielsen); Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Drs Bjerre, Mols, Frausing, Witt, Eiskjær, Løgstrup, Kronborg, and Nielsen); and Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (Mr Bakos and Ms Horváth-Puhó)
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Bigot M, Guy JM, Monpere C, Cohen-Solal A, Pavy B, Iliou MC, Bosser G, Corone S, Douard H, Farrokhi T, Guerder A, Guillo P, Houppe JP, Pezel T, Pierre B, Roueff S, Thomas D, Verges B, Blanchard JC, Ghannem M, Marcadet D. Cardiac rehabilitation recommendations of the Group Exercise Rehabilitation Sports - Prevention (GERS-P) of the French Society of Cardiology: 2023 update. Arch Cardiovasc Dis 2024; 117:521-541. [PMID: 39174436 DOI: 10.1016/j.acvd.2024.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Muriel Bigot
- Centre de réadaptation cardiaque, Cardiocéan, 17138 Puilboreau, France.
| | - Jean Michel Guy
- Le Clos Champirol rééducation, 42270 Saint-Priest-en-Jarez, France
| | | | - Alain Cohen-Solal
- Service de cardiologie, centre de réadaptation cardiaque, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Inserm UMRS-942, université Paris Cité, 75010 Paris, France
| | - Bruno Pavy
- Service de réadaptation cardiovasculaire, CH Loire Vendée Océan, 44270 Machecoul, France
| | - Marie Christine Iliou
- Centre de réadaptation cardiaque, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Gilles Bosser
- Service de cardiologie pédiatrique et congénitale, CHU Nancy, 54600 Vandœuvre-Lès-Nancy, France
| | - Sonia Corone
- Service réadaptation cardiaque, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France
| | | | - Titi Farrokhi
- Service réadaptation cardiaque, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France
| | - Antoine Guerder
- Service de pneumologie, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Pascal Guillo
- Centre de réadaptation Saint-Yves, 35000 Rennes, France
| | | | - Theo Pezel
- Service de cardiologie, hôpital Lariboisière, AP-HP, université Paris Est Créteil, 75010 Paris, France
| | | | - Stephane Roueff
- Service de néphrologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - Daniel Thomas
- Institut de cardiologie Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | | | | | - Mohamed Ghannem
- Service de cardiologie, hôpital de Gonesse, faculté de médecine, Sousse, Tunisia; Université Picardie Jules-Verne, 80000 Amiens, France
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Mazza M, Biondi-Zoccai G, Lisci FM, Brisi C, Sfratta G, Rossi S, Traversi G, Gaetani E, Pola R, Morini S, Romagnoli E, Simeoni B, Covino M, Marano G. The Brain-Heart Axis: An Umbrella Review on Impact of Psychiatric Disease on Incidence, Management, and Outlook of Cardiovascular Disease. Life (Basel) 2024; 14:919. [PMID: 39202662 PMCID: PMC11355298 DOI: 10.3390/life14080919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 09/03/2024] Open
Abstract
Psychiatric conditions, such as depression, anxiety, bipolar disorder, and schizophrenia, are increasingly recognized as significant risk factors for cardiovascular disease (CVD). This review systematically analyzes evidence from various databases to provide a comprehensive understanding of the impact of psychiatric illnesses on the incidence, management, and prognosis of CVD. Key findings suggest a bidirectional relationship between psychiatric disorders and CVD, indicating that mental health conditions can predispose individuals to CVD, while CVD can exacerbate or trigger psychiatric symptoms. The review explores the underlying mechanisms of these associations, including behavioral factors, stress responses, and medication side effects. It also examines the challenges in managing CVD patients with comorbid psychiatric conditions, emphasizing the importance for integrated care approaches. This review underscores the necessity of considering mental health as an integral component of cardiovascular care and calls for further research to develop tailored management strategies for these complex conditions, ultimately aiming to improve patient outcomes and quality of life. This comprehensive analysis provides valuable insights for future investigations and guides clinicians in optimizing care for patients with both psychiatric and cardiovascular conditions.
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Affiliation(s)
- Marianna Mazza
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy
| | - Francesco Maria Lisci
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Caterina Brisi
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Greta Sfratta
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Rossi
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gianandrea Traversi
- Unit of Medical Genetics, Department of Laboratory Medicine, Ospedale Isola Tiberina-Gemelli Isola, 00186 Rome, Italy;
| | - Eleonora Gaetani
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Unit of Internal Medicine, Cristo Re Hospital, 00167 Rome, Italy
| | - Roberto Pola
- Section of Internal Medicine and Thromboembolic Diseases, Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sofia Morini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Benedetta Simeoni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Marano
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Gragnano A, Corbière M, Picco E, Negrini A, Savioli G, Conti M, Corsiglia L, Miglioretti M. Adaptation and validation of the cardiovascular version of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES-CVD) to the Italian context. Disabil Rehabil 2023; 45:3573-3581. [PMID: 36124555 DOI: 10.1080/09638288.2022.2123962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Andrea Gragnano
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Marc Corbière
- Department of Education, Career counselling, Université du Québec à Montréal, Montreal, Canada
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, Canada
| | - Eleonora Picco
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Alessia Negrini
- Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail (IRSST), Montreal, Canada
| | - Gaia Savioli
- Cardiovascular Institute of Camogli (ISCC), Camogli, Italy
| | - Massimo Conti
- Cardiovascular Institute of Camogli (ISCC), Camogli, Italy
| | - Luca Corsiglia
- Cardiovascular Institute of Camogli (ISCC), Camogli, Italy
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Mai Q, Xu S, Hu J, Sun X, Chen G, Ma Z, Song Y, Wang C. The association between socioeconomic status and health-related quality of life among young and middle-aged maintenance hemodialysis patients: multiple mediation modeling. Front Psychiatry 2023; 14:1234553. [PMID: 37795510 PMCID: PMC10546310 DOI: 10.3389/fpsyt.2023.1234553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023] Open
Abstract
Objective To explore the relationship between socioeconomic status (SES), illness perception, social functioning, and health-related quality of life (HRQoL) of young and middle-aged maintenance hemodialysis (MHD) patients and the internal mechanism of action. Design A multicenter cross-sectional study. Methods An aggregate of 332 young and middle-aged MHD patients were enrolled from hemodialysis centers in four general hospitals in Guangzhou, Guangdong, China, from June to December 2022. The questionnaires used included one for general demographic data, the Brief Illness Perception Questionnaire (BIPQ), Social Dysfunction Screening Scale (SDSS), and the 12-item Short Form Health Survey (SF-12). Results Both SES and HRQoL were negatively correlated with illness perception and social functioning, respectively. SES was positively correlated with HRQoL. Illness perception was positively correlated with social functioning. The indirect effects of illness perception and social functioning on the relationship between SES and HRQoL were 0.33 and 0.31, making up 41.06% and 38.91% of the sum. The chain indirect effect of illness perception and social functioning was 0.10, making up 12.59% of the total effect, while gender did not play a moderating role. Conclusion Illness perception and social functioning may independently and accumulatively mediate the association between SES and HRQoL. Nurses should consider developing individual intervention program for young and middle-aged MHD patients with low SES, focusing on establishing targeted counseling and health education strategies corresponding to illness perception and social functioning to help patients improve their HRQoL.
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Affiliation(s)
- Qingxin Mai
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyi Xu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingyi Hu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoming Sun
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gangyi Chen
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen Ma
- Department of Nephrology, Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou, China
| | - Yang Song
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chao Wang
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Scafa F, Gallozzi A, Forni G, Candura SM. Work resumption after invasive heart procedures, rehabilitation and ergonomic evaluation: from the hospital to the workplace. Monaldi Arch Chest Dis 2023; 94. [PMID: 37667891 DOI: 10.4081/monaldi.2023.2689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 09/06/2023] Open
Abstract
Our Institute adopts a multidisciplinary protocol named "CardioWork" for work resumption after invasive cardiac procedures and subsequent rehabilitation: after evaluation of the cardiac functional profile, the occupational physician analyzes the work activity prior to the cardiopathological event, identifies the presumed task energy requirement (from specific, published tables), and compares it with the exercise test results. Indications regarding the timing and modality of returning to work are formulated accordingly. To verify the reliability of the indications thus provided, we carried out a clinical-functional follow-up study in the workplace with Holter electrocardiography (ECG) and armband measurement of actual energy expenditure. Over the course of 2 years, we enrolled 36 patients (mostly males, aged between 30 and 70 years) who were hospitalized after coronary revascularization, valve replacement, or cardiac defibrillator implant. After rehabilitation, instrumental diagnostics (Holter ECG, echocardiography, exercise test) showed discrete functional conditions, with better values with regard to cardiac function than exercise capacity and effort tolerance. All subjects were judged fit for the job, in most cases with limitations concerning ergonomic factors, working timetable, and/or stress. They returned to work quickly, with good adherence to the indications provided. The workplace Holter ECG did not show appreciable differences compared to the hospital evaluation. In one case, the average energy expenditure measured while working was higher than that inferred from the tables; in the remaining subjects, the actual expenditure coincided with what was expected or was lower. In a minority of cases (39%), the measured average expenditure slightly exceeded the optimal value (35% of the maximal value at the exercise test) recommended at the time of hospital discharge. At the end of the workplace evaluation, it was not necessary to formulate new indications. The study provides further evidence of the effectiveness of the CardioWork protocol in promoting a return to work after invasive heart procedures. Although they need continuous updating, the published estimates of presumed task energy requirements remain reliable. In particularly complex cases, however, it is advisable to carry out a field check of the ergometric assessments performed at the end of rehabilitation.
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Affiliation(s)
- Fabrizio Scafa
- Occupational Medicine Unit, Department of Public Health, Experimental and Forensic Sciences, University of Pavia; Occupational Medicine Unit, ICS Maugeri IRCCS, Pavia.
| | - Alessia Gallozzi
- Occupational Medicine Unit, Department of Public Health, Experimental and Forensic Sciences, University of Pavia; Occupational Medicine Unit, ICS Maugeri IRCCS, Pavia.
| | - Giovanni Forni
- Rehabilitation Cardiology Unit, ICS Maugeri IRCCS, Pavia.
| | - Stefano M Candura
- Occupational Medicine Unit, Department of Public Health, Experimental and Forensic Sciences, University of Pavia; Occupational Medicine Unit, ICS Maugeri IRCCS, Pavia.
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Andersen EB, Kristiansen M, Bernt Jørgensen SM. Barriers and facilitators to return to work following cardiovascular disease: a systematic review and meta-synthesis of qualitative research. BMJ Open 2023; 13:e069091. [PMID: 36707117 PMCID: PMC9884880 DOI: 10.1136/bmjopen-2022-069091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Return to work is a key rehabilitation goal, however, people recovering from cardiovascular disease (CVD) often struggle with returning to work. The aim of this study was to conduct a systematic review and meta-synthesis of the existing qualitative evidence on barriers and facilitators to return to work experienced by people with CVD. METHODS A systematic literature search was conducted in PubMed, Embase, Web of Science, PsycINFO, Scopus and CINAHL in August 2022. The reference lists of the included articles were searched. The Critical Appraisal Skills Programme was used for quality appraisal and a meta-synthesis was employed. FINDINGS This review includes 15 studies of overall high methodological quality. Barriers covered four themes: physical limitations, psychological and relational factors, the working context and support within health and social care systems. Facilitators were related to five themes: return to normality, enhancing well-being, financial concerns, the working context and support within health and social care systems. CONCLUSION Our findings highlight that return to work following CVD is a complex process influenced by individual factors, as well as work-related factors, factors in the health and social care systems and social security policies and regulations. To improve return to work, this review illustrates a need for individualised, multidisciplinary and coordinated vocational rehabilitation programmes that accommodate potential barriers to re-employment. Similarly, this review highlights how vocational rehabilitation programmes should ensure individualised information and support early in the rehabilitation process, as well as the importance of engaging relevant stakeholders, such as employers, in making individualised return-to-work plans.
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Affiliation(s)
- Emma Borre Andersen
- Section of Cardiovascular Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Sidsel Marie Bernt Jørgensen
- Section of Cardiovascular Research, The Danish Heart Foundation, Copenhagen, Denmark
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Bernt Jørgensen SM, Gerds TA, Johnsen NF, Gislason G, El-Chouli M, Brøndum S, Maribo T, Kristiansen M. Diagnostic group differences in return to work and subsequent detachment from employment following cardiovascular disease: a nationwide cohort study. Eur J Prev Cardiol 2023; 30:182-190. [PMID: 36316291 DOI: 10.1093/eurjpc/zwac249] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
AIMS Return to work and employment maintenance following cardiovascular disease (CVD) are important rehabilitation goals for people of working age. To identify people in particular need of vocational rehabilitation, we examined differences in return to work and subsequent detachment from employment among people with atrial fibrillation (AF), heart failure (HF), heart valve disease, and ischaemic heart disease. METHODS AND RESULTS We conducted a nationwide cohort study and included all individuals of working age (35-65 years) who were employed when diagnosed with incident CVD in 2018. We estimated sex- and age-standardized probabilities of remaining employed at 3, 6, and 12 months after diagnosis, and of detachment from employment within 6 months after having returned to work. Of 46 912 individuals diagnosed in 2018, 8187 were of working age and employed at diagnosis. The mean age was 54.7 years (SD = 6.7), and 74.0% were men. Within 1 year, 89.8% had returned to work, but within the subsequent 6 months, 23.5% of these experienced detachment from employment. At 3, 6, and 12 months after diagnosis the highest standardized probability of being employed was found among people with AF, whereas the lowest probability was found among people with HF {78.9% [95% confidence interval (CI): 77.3-80.4] vs. 62.2% [95% CI: 59.0-65.4] at 12 months}. Similarly, the highest probability of detachment was found for people with HF [30.3% (95% CI: 26.9-33.7)]. CONCLUSION People with HF present the highest probability of not returning to work. There is a need for developing and documenting effects of vocational rehabilitation strategies within comprehensive cardiac rehabilitation programmes.
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Affiliation(s)
- Sidsel Marie Bernt Jørgensen
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
- Department of Public Health & Center for Healthy Aging, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Thomas Alexander Gerds
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
- Department of Public Health, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Nina Føns Johnsen
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
| | - Gunnar Gislason
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Mohamad El-Chouli
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
| | - Stig Brøndum
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- DEFACTUM, Central Denmark Region, P. P. Ørums Gade 11, 8000 Aarhus C, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
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Krakov AO, Tzuberi M, Hodik G, Rinsky-Halivni L, Sahar Kostis Y, Moshe S. The implementation of clinical guidelines concerning return to work after myocardial infarction. Disabil Rehabil 2022; 44:7848-7853. [PMID: 34894930 DOI: 10.1080/09638288.2021.2000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To examine the implementation, clinical effects, and adherence of occupational physicians to the clinical practice guidelines (CPG) published in 2003 in Israel, regarding return to work following acute myocardial infarction (AMI). METHODS We analyzed 3 populations referred to Maccabi Health Services occupational clinics for fitness for work examinations following AMI, either before the guidelines were published (group 1), after their first publications in 2003 (group 2) or after they were re-published in Harefuah Journal in 2007 (group3). RESULTS The documentation among groups 1,2,3 of different parameters like years of education (18.8%, 45.1%. 57.5%, p < 0.001), type of occupation (86.5%, 98.2%, 100.0%, p < 0.001) and New York Heart Association (NYHA) class (69.8%, 81.4%, 92.5%, p < 0.001) has all improved respectively over the years. No significant difference in sick leave was noted between the three populations. CONCLUSION The CPG should be interdisciplinary in the phase of writing and publication. Economical resources are needed in order to implement CPG.Implications for RehabilitationThe clinical practice guidelines should be interdisciplinary in the phase of writing and should involve all rehabilitation professionals as a team.The clinical practice guidelines need disseminating widely alongside a resource plan in order to implement it.
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Affiliation(s)
- Ayala Olga Krakov
- The Occupational Medicine Department, Maccabi Healthcare Services, Rishon Letzion, Israel.,The Division of Environmental and Occupational Medicine, The School of Public Health, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Miri Tzuberi
- The Department of Physiotherapy, Central District, Maccabi Healthcare Services, Tel-Aviv Israel
| | - Gabriel Hodik
- The Division of Environmental and Occupational Medicine, The School of Public Health, Sackler Faculty of Medicine, Tel-Aviv, Israel.,Maccabi Healthcare Services, Central Headquarter, Tel-Aviv, Israel
| | - Lilah Rinsky-Halivni
- The Department of Occupational Medicine, Clalit Health Services, Tel-Aviv, Israel.,Braun School of Public Health and Community Medicine, Hadassah-Hebrew University Medical School, Jerusalem, Israel.,Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Boston, USA
| | - Yael Sahar Kostis
- The Division of Environmental and Occupational Medicine, The School of Public Health, Sackler Faculty of Medicine, Tel-Aviv, Israel.,The Department of Occupational Medicine, Clalit Health Services, Tel-Aviv, Israel
| | - Shlomo Moshe
- The Occupational Medicine Department, Maccabi Healthcare Services, Rishon Letzion, Israel.,The Division of Environmental and Occupational Medicine, The School of Public Health, Sackler Faculty of Medicine, Tel-Aviv, Israel
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11
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Perceived return-to-work pressure following cardiovascular disease is associated with age, sex, and diagnosis: a nationwide combined survey- and register-based cohort study. BMC Public Health 2022; 22:1059. [PMID: 35624504 PMCID: PMC9135990 DOI: 10.1186/s12889-022-13494-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Return to work is a key rehabilitation goal for people with cardiovascular disease (CVD) because employment matters to individuals and societies. However, people recovering from CVD often struggle with returning to work and maintaining employment. To identify people in need of vocational counselling, we examined the probability of feeling under pressure to return to work following CVD. Methods We conducted a combined survey- and register-based study in a randomly selected, population-based cohort of 10,000 people diagnosed with atrial fibrillation, heart failure, heart valve disease, or ischaemic heart disease in 2018. The questionnaire covered return-to-work items, and we reported the probabilities of feeling under pressure to return to work with 95% confidence intervals (CIs) in categories defined by sex, age, and CVD diagnosis. Results The survey response rate was 51.1%. In this study, we included 842 respondents (79.7% men) aged 32–85 years, who had returned to work following a sick leave. Overall, 249 (29.7%) had felt pressure to return to work. The probability of feeling under pressure to return to work ranged from 18.3% (95% CI: 13.1–24.6) among men aged > 55 years with atrial fibrillation to 51.7% (95% CI: 32.5–70.6) among women aged ≤ 55 years with atrial fibrillation. In addition, 66.0% of all respondents had not been offered vocational rehabilitation, and 48.6% of those who reported a need for vocational counselling had unmet needs. Survey responses also indicated that many respondents had returned to work before feeling mentally and physically ready. Conclusion A substantial proportion of people with cardiovascular disease feel under pressure to return to work, and this pressure is associated with age, sex, and diagnosis. The results show that vocational rehabilitation must be improved and emphasize the importance of ensuring that cardiac rehabilitation programmes include all core rehabilitation components.
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12
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Zack O, Melamed S, Silber H, Cinamon T, Levy D, Moshe S. The Effectiveness of Case-management Rehabilitation Intervention in Facilitating Return to Work and Maintenance of Employment After Myocardial Infarction: Results of a Randomized Controlled Trial. Clin Rehabil 2022; 36:753-766. [PMID: 35191331 PMCID: PMC9082965 DOI: 10.1177/02692155221076826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective To study the long-term effectiveness of case-management rehabilitation intervention on vocational reintegration of patients after myocardial infarction (MI). Design Blinded simple randomization was used to construct an intervention and control groups that were followed up for two years. Subjects and setting 151 patients, aged 50.3 ± 5.9 years, who experienced uncomplicated MI and were enrolled in a cardiac rehabilitation program were recruited. Interventions included an early referral to an occupational physician, tailoring an occupational rehabilitation program, based on individual patient needs, coordination with relevant parties, psychosocial intervention, intensive follow-up sessions during a two-year follow-up. Main measures Return to work within six months of hospitalization and maintenance of employment at one and two years of follow-up. Results Return-to-work (RTW) rate in the intervention group was 89% and nearly all maintained employment at one year of follow-up (92%) and two years of follow-up (87%). Moreover, almost all of them returned to and maintained their previous jobs. The corresponding figures were: 98%, 94% and 98%, respectively. The figures for the RTW and employment maintenance for the control group were: 74%, 75%, and 72%, respectively. Only about 75%, in this group kept their previous job. The case-management intervention was associated with increased odds of maintaining employment at follow-up of one year (OR = 5.89, 95% CI 1.42–24.30) and two years (OR = 3.12, 95% CI 1.01–10.03). Conclusions The extended case-management rehabilitation intervention had a substantial positive impact on both the RTW of MI patients and their maintenance of employment at one and two years of follow-up. Trial Registration This trial is registered at US National Institutes of Health #NCT04934735.
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Affiliation(s)
- Oren Zack
- Department of Environmental and Occupational Health, The School of Public Health, Sackler Faculty of Medicine, 58408Tel-Aviv University, Tel-Aviv, Israel
| | - Samuel Melamed
- Department of Environmental and Occupational Health, The School of Public Health, Sackler Faculty of Medicine, 58408Tel-Aviv University, Tel-Aviv, Israel
| | | | - Tali Cinamon
- The Authority of Public Complaints, 50092Maccabi Healthcare Services, Tel Aviv, Israel
| | - Doron Levy
- The Department of Occupational Medicine, Hashfela and Jerusalem District, 50092Maccabi Healthcare Services, Rishon Letzion, Israel
| | - Shlomo Moshe
- Department of Environmental and Occupational Health, The School of Public Health, Sackler Faculty of Medicine, 58408Tel-Aviv University, Tel-Aviv, Israel.,The Department of Occupational Medicine, Hashfela and Jerusalem District, 50092Maccabi Healthcare Services, Rishon Letzion, Israel
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13
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Blokzijl F, Onrust M, Dieperink W, Keus F, van der Horst ICC, Paans W, Mariani MA, Reneman MF. Barriers That Obstruct Return to Work After Coronary Bypass Surgery: A Qualitative Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:316-322. [PMID: 32803466 PMCID: PMC8172483 DOI: 10.1007/s10926-020-09919-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Coronary artery bypass grafting is the most frequently performed cardiac surgical procedure. Despite its benefits on survival and quality of life, it is associated with a considerable financial burden on society including sick leave. Our study aimed to explore the barriers that obstruct return to work after coronary artery bypass grafting. Methods We performed a qualitative study with in-depth interviewing of patients 6 months after their surgery. We included ten working patients and interviewed them and their spouses at home. The interviews were transcribed and two investigators independently searched the transcriptions for barriers that had obstructed return to work. Results Based on the interviews we were able to distinguish four main groups of barriers: 'personal', 'healthcare', 'work' and 'law & regulation.' The personal barriers were subgrouped in affective, physical, cognitive, social and individually determined factors. Conclusion In a qualitative study we showed that personal barriers as well as barriers regarding healthcare, work and law & regulation, were perceived by patients as important factors obstructing return to work after coronary artery bypass grafting. To overcome the identified barriers, the process of return to work could preferably be initiated during the hospital phase, started during cardiac rehabilitation, and coordinated by a case-managing professional.
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Affiliation(s)
- Fredrike Blokzijl
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Marisa Onrust
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Willem Dieperink
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Center+, University of Maastricht, Maastricht, The Netherlands
| | - Wolter Paans
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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14
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Halasz G, Piepoli MF. Editors' introduction: focus on cardiovascular rehabilitation. Eur J Prev Cardiol 2021; 28:457-459. [PMID: 33930143 DOI: 10.1093/eurjpc/zwab069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Geza Halasz
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo F Piepoli
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
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15
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Gecaite-Stonciene J, Bunevicius A, Burkauskas J, Brozaitiene J, Neverauskas J, Mickuviene N, Kazukauskiene N. Validation of the Multidimensional Fatigue Inventory with Coronary Artery Disease Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218003. [PMID: 33143183 PMCID: PMC7662819 DOI: 10.3390/ijerph17218003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Fatigue is a common distressing symptom in patients with coronary artery disease (CAD). The Multidimensional Fatigue Inventory (MFI) is used for measuring fatigue in various clinical settings. Nevertheless, its multidimensional structure has not been consistent across studies. Thus, we aimed to psychometrically evaluate the MFI in patients with CAD. METHODS In sum, 1162 CAD patients completed questionnaires assessing their subjective fatigue level (MFI-20), mental distress symptoms (HADS, STAI), and health-related quality of life (SF-36). Participants also completed exercise capacity (EC) testing. RESULTS Confirmatory factor analysis of the four-factor model, showed acceptable fit (CFI = 0.905; GFI = 0.895; NFI = 0.893, RMSEA = 0.077). After eliminating four items, confirmatory factor analysis testing showed improvement in the four-factor model of the MFI-16 (CFI = 0.910; GFI = 0.909; NFI = 0.898, RMSEA = 0.077). Internal consistency values were adequate for the total score and four MFI-16 subscales: General fatigue, physical fatigue, reduced activity, and mental fatigue with Cronbach's α range: 0.60-0.82. The inadequate value (Cronbach's α = 0.43) was received for the subscale of reduced motivation in both MFI-20 and MFI-16. Correlations between the MFI-16 and HADS, STAI, SF-36, and EC measures were statistically significant (all p's < 0.001). CONCLUSIONS The Lithuanian version of the modified MFI of 16 items showed good factorial structure and satisfactory psychometric characteristics, except for reduced motivation subscale.
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16
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Abreu A, Frederix I, Dendale P, Janssen A, Doherty P, Piepoli MF, Völler H, Davos CH. Standardization and quality improvement of secondary prevention through cardiovascular rehabilitation programmes in Europe: The avenue towards EAPC accreditation programme: A position statement of the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2020; 28:496-509. [PMID: 33611459 DOI: 10.1177/2047487320924912] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/21/2019] [Indexed: 12/17/2022]
Abstract
Despite the proven efficacy and cost-effectiveness of contemporary cardiovascular rehabilitation programmes, the referral to/uptake of and adherence to cardiovascular rehabilitation remains inadequate. In addition, heterogeneity persists amongst different cardiovascular rehabilitation centres in Europe, despite the available scientific documents describing the evidence-based rehabilitation format/content. This position statement was elaborated by the Secondary Prevention and Rehabilitation (SP/CR) section of EAPC. It defines the minimal and optimal cardiovascular rehabilitation standards. In addition, it describes the relevant quality indicators of cardiovascular rehabilitation programmes to date. Compliance of European cardiovascular rehabilitation centres with these standards will improve cardiovascular rehabilitation process standardization in Europe and hence increase the quality of cadiovascular rehabilitation programmes.
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Affiliation(s)
- Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Portugal.,Centro Académico de Medicina de Lisboa (CAML), Universidade de Lisboa, Portugal.,Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL)
| | - Ines Frederix
- Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL).,Faculty of Medicine and Life Sciences, Hasselt University, Belgium.,Department of Cardiology, Jessa Hospital, Belgium.,Faculty of Medicine & Health Sciences, Antwerp University, Belgium
| | - Paul Dendale
- Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL).,Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Arne Janssen
- Faculty of Medicine & Health Sciences, Antwerp University, Belgium
| | | | - Massimo F Piepoli
- Department of Health Sciences, University of York, UK.,Heart Failure Unit, G da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Heinz Völler
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy.,Department of Cardiology, Klinik am See, Germany
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- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Germany
| | - Constantinos H Davos
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Italy
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17
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18
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Olsen SJ, Schirmer H, Wilsgaard T, Bønaa KH, Hanssen TA. Employment status three years after percutaneous coronary intervention and predictors for being employed: A nationwide prospective cohort study. Eur J Cardiovasc Nurs 2020; 19:433-439. [PMID: 32106706 DOI: 10.1177/1474515120903614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vocational support is recommended for patients in cardiac rehabilitation (CR), as returning to work is important in patients social readjusting after an acute coronary event. Information is lacking on whether CR leads to higher long-term employment after percutaneous coronary intervention (PCI). AIMS The aims of this study were to determine employment status three years after PCI, to compare employment status between CR participants and CR non-participants and to assess predictors for employment. METHODS We included first-time PCI patients from the NorStent trial, who were of working age (<63 years; n = 2488) at a three-year follow-up. Employment status and CR participation were assessed using a self-report questionnaire. Propensity score method was used in comparing employment status of CR participants and CR non-participants. RESULTS Seventy per cent of participants who were <60 years of age at the index event were employed at follow-up and CR participation had no effect on employment status. Being male, living with a partner and attaining higher levels of education were associated with a higher chance of being employed, while being older, prior cardiovascular morbidity and smoking status were associated with lower chance of being employed at follow-up. CONCLUSION Because a significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization, updated incentives should be implemented to promote vocational support. Such programmes should focus on females, patients lacking higher education and patients who are living alone, as they are more likely to remain unemployed.
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Affiliation(s)
- Siv Js Olsen
- The Arctic University of Norway, Harstad, Norway
| | - Henrik Schirmer
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Kaare H Bønaa
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway
| | - Tove A Hanssen
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Heart Disease, University Hospital of North Norway, Tromsø, Norway
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Salzwedel A, Reibis R, Hadzic M, Buhlert H, Völler H. Patients' expectations of returning to work, co-morbid disorders and work capacity at discharge from cardiac rehabilitation. Vasc Health Risk Manag 2019; 15:301-308. [PMID: 31616150 PMCID: PMC6698615 DOI: 10.2147/vhrm.s216039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/28/2019] [Indexed: 12/24/2022] Open
Abstract
Objective We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR). Methods We analyzed routine data of 884 patients (52±7 years, 76% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were considered. Results A negative occupational prognosis was detected in 384 patients (43%). Out of these, 368 (96%) expected not to return to work after CR and/or were unemployed before CR at 29% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12% vs 3%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95% CI 0.2–0.6, P<0.01), negative occupational expectations (OR 0.4, 95% CI 0.3–0.7, P<0.01) and depression (OR 0.3, 95% CI 0.1–0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated. Conclusion Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients’ occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.
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Affiliation(s)
- Annett Salzwedel
- Department of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Rona Reibis
- Cardiological Outpatient Clinik Am Park Sanssouci, Potsdam, Germany
| | - Miralem Hadzic
- Department of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Hermann Buhlert
- Department of Cardiology, Klinik Am See, Rehabilitation Centre of Cardiovascular Diseases, Rüdersdorf, Germany
| | - Heinz Völler
- Department of Rehabilitation Research, University of Potsdam, Potsdam, Germany.,Department of Cardiology, Klinik Am See, Rehabilitation Centre of Cardiovascular Diseases, Rüdersdorf, Germany
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20
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Salzwedel A, Völler H, Reibis R. Vocational reintegration in coronary heart disease patients - the holistic approach of the WHO biopsychosocial concept. Eur J Prev Cardiol 2019; 26:1383-1385. [PMID: 31091981 DOI: 10.1177/2047487319850699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Annett Salzwedel
- 1 Department of Rehabilitation Research, University of Potsdam, Germany
| | - Heinz Völler
- 1 Department of Rehabilitation Research, University of Potsdam, Germany.,2 Klinik am See, Rehabilitation Centre of Cardiovascular Diseases, Rüdersdorf, Germany
| | - Rona Reibis
- 3 Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
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