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Saarinen SL, Borregaard B, Ekholm O, Christensen AV, Thorup CB, Thomsen T, Thrysoee L, Mols RE, Juel K, Berg SK, Rasmussen TB. Self-reported mental and physical health is associated with not returning to work in patients with ischemic heart disease. Int J Cardiol 2024; 409:132180. [PMID: 38759797 DOI: 10.1016/j.ijcard.2024.132180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Ischemic Heart Disease (IHD) can lead to prolonged sick leave and loss of ability to work. This study aimed to describe non-return to work (non-RTW) across three IHD subgroups at 3 and at 12 months post discharge, and explore whether baseline characteristics, and patient-reported mental and physical health were associated with work detachment. METHODS Data from the national cohort study DenHeart were used, including the patient-reported outcomes (PROs) Short-Form 12, Hospital Anxiety and Depression Scale, Edmonton Symptom Assessment Scale and HeartQoL measured at discharge and register-based follow-up at 3 and at 12 months. A total of 3873 patients with IHD ≤ 63 years old and part of the workforce prior to hospitalisation, were included in the analyses and divided into three groups: chronic IHD/stable angina, non-STEMI (non-ST-Elevation Myocardial Infarction)/unstable angina and STEMI (ST-Elevation Myocardial Infarction). A composite outcome of 'prolonged sick leave' and/or 'left the workforce' was defined as non-return to work (non-RTW). Adjusted logistic regression models were performed. RESULTS Overall, the frequency of non-RTW was 37.7% and 38.0% at 3 and 12 months, respectively, thus not improving with time. The largest proportion of non-RTW was found in STEMI patients, followed by non-STEMI/unstable angina and IHD/stable angina patients. Several clinical and socio-demographic factors, as well as patient-reported mental and physical health were associated with non-RTW among the subgroups. CONCLUSION The findings demonstrate a need for identifying IHD patients at risk of non-RTW after discharge based on their mental and physical health and a need for initiatives to minimize unwanted non-RTW.
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Affiliation(s)
- Stine Lise Saarinen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Thordis Thomsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Acute, Critical and Emergency Care Science Unit, Department of Anaesthesiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
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Rosenkranz SH, Wichmand CH, Smedegaard L, Møller S, Bjerre J, Schou M, Torp-Pedersen C, Philbert BT, Larroudé C, Melchior TM, Nielsen JC, Johansen JB, Riahi S, Holmberg T, Gislason G, Ruwald AC. Workforce affiliation in primary and secondary prevention implantable cardioverter defibrillator patients: a nationwide Danish study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:314-325. [PMID: 37682525 DOI: 10.1093/ehjqcco/qcad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND AIM There are a paucity of studies investigating workforce affiliation in connection with first-time implantable cardioverter defibrillator (ICD)-implantation. This study explored workforce affiliation and risk markers associated with not returning to work in patients with ICDs. METHODS Using the nationwide Danish registers, patients with a first-time ICD-implantation between 2007 and 2017 and of working age (30-65 years) were identified. Descriptive statistic and logistic regression models were used to describe workforce affiliation and to estimate risk markers associated with not returning to work, respectively. All analyses were stratified by indication for implantation (primary and secondary prevention). RESULTS Of the 4659 ICD-patients of working age, 3300 patients (71%) were members of the workforce (employed, on sick leave or unemployed) (primary: 1428 (43%); secondary:1872 (57%)). At baseline, 842 primary and 1477 secondary prevention ICD-patients were employed. Of those employed at baseline, 81% primary and 75% secondary prevention ICD-patients returned to work within 1 year, whereof more than 80% remained employed the following year. Among patients receiving sick leave benefits at baseline, 25% were employed after 1 year. Risk markers of not returning to work were 'younger age' in primary prevention ICD-patients, while 'female sex', left ventricular ejection fraction 'LVEF ≤40', 'lower income', and '≥3 comorbidities' were risk markers in secondary prevention ICD-patients. Lower educational level was a risk marker in both patient groups. CONCLUSION High return-to-work proportions following ICD-implantation, with a subsequent high level of employment maintenance were found. Several significant risk markers of not returning to work were identified including 'lower educational level' that posed a risk in both patient groups. TRIAL REGISTRATION NUMBER Capital Region of Denmark, P-2019-051.
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Affiliation(s)
- Simone H Rosenkranz
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Charlotte H Wichmand
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Lærke Smedegaard
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Sidsel Møller
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- The Emergency Medical Services Copenhagen, Capital Region of Denmark
| | - Jenny Bjerre
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Berit T Philbert
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Larroudé
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Thomas M Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
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3
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Bermon A, Trejo-Valdivia B, Molina Castaño CF, Segura AM, Serrano NC. Time-Dependent Risk for Recurrence in Survivors of Major Adverse Cardiovascular Events. Cureus 2024; 16:e59366. [PMID: 38817508 PMCID: PMC11138715 DOI: 10.7759/cureus.59366] [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] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The prevalence of the population with a history of an occlusive cardiovascular event has been increasing in recent years, which means that a large number of patients will have a higher risk of presenting a fatal recurrence. The aim is to determine variables associated with time-to-recurrent cardiovascular events and analyze how changes in low-density lipoprotein cholesterol (LDL-C) levels during follow-up may be associated with this time-to-event. MATERIALS AND METHODS This is a prospective observational cohort study of 727 adults with a history of at least one occlusive cardiovascular event recruited at a referral hospital in northeastern Colombia. Data from a follow-up period of a maximum of 33 months (median 26 months) (one death) were used to define how clinical and sociodemographic variables impact the recurrence of major adverse cardiovascular events (MACE). Analyses were performed based on proportional hazard models and time-dependent hazard models. RESULTS Upon enrollment, 215 (30%) of the participants reported experiencing their most recent cardiovascular event within the preceding year. After two years, the recurrence rate was 12.38% (90/727). The risk of recurrence before two years was 3.9% (95% CI 2.7-5.6). In the multiple models, the presence of severe depression gives a Hazard Ratio of 8.25 (95% CI 2.98-22.86) and LDL ≥120 md/dl Hazard Ratio of 2.12 (95% CI 1.2 -3.9). It was found that LDL >120 mg/dl maintained over time increases the chances of recurrence by 1.7% (Hazard Ratio: 1.017, 95% CI 0.008-0.025). CONCLUSIONS The present study allows us to identify a profile of patients who should be treated promptly in an interdisciplinary manner to avoid recurrences of coronary events.
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Affiliation(s)
- Anderson Bermon
- Centro de Investigaciones, Fundación Cardiovascular de Colombia, Bucaramanga, COL
- Escuela de graduados, Universidad CES, Medellín, COL
| | - Belem Trejo-Valdivia
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, MEX
| | - Carlos Federico Molina Castaño
- Epidemiology, Tecnológico de Antioquia Institución Universitaria, Medellin, COL
- Escuela de graduados, Universidad CES, Medellín, COL
| | | | - Norma C Serrano
- Centro de Investigaciones, Fundación Cardiovascular de Colombia, Bucaramanga, COL
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Kai SHY, Ferrières J, Rossignol M, Bouisset F, Herry J, Esquirol Y. Prevalence and determinants of return to work after various coronary events: meta-analysis of prospective studies. Sci Rep 2022; 12:15348. [PMID: 36097026 PMCID: PMC9468005 DOI: 10.1038/s41598-022-19467-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 08/30/2022] [Indexed: 11/29/2022] Open
Abstract
Return to work (RTW) after a coronary event remains a major concern. This systematic review and meta-analysis of prospective studies published between January 1988 and August 2020, aim to evaluate the prevalence of RTW after a coronary event (myocardial infarction, acute coronary syndrome, angina pectoris) and to assess the determinants of RTW (such as follow-up duration, date of recruitment, country, gender, occupational factors, etc.). PRISMA and MOOSE guidelines were followed. Study quality was assessed using the Newcastle–Ottawa Scale. Random-effects models were carried out to determine pooled prevalence estimates and 95% confident interval. A total of 43 prospective studies (34,964 patients) were investigated. RTW overall random effects pooled prevalence was estimated at 81.1% [95% CI 75.8–85.8]. Country, year of implementation or gender did not significantly modify the prevalence estimates. Lower level of education and degraded left ventricular ejection fraction decreased RTW prevalence estimates (respectively, 76.1% vs 85.6% and 65.3% vs 77.8%). RTW prevalence estimates were higher for white-collars (81.2% vs 65.0% for blue-collars) and people with low physical workload (78.3% vs 64.1% for elevated physical workload).Occupational physical constraints seem to have a negative role in RTW while psycho-logical factors at work are insufficiently investigated. A better understanding of the real-life working conditions influencing RTW would be useful to maintain coronary patients in the labor market.
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Affiliation(s)
- Samantha Huo Yung Kai
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Epidemiology, Toulouse University Hospital, 31000, Toulouse, France
| | - Jean Ferrières
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Cardiology, Toulouse University Hospital, 31400, Toulouse, France
| | - Mélisande Rossignol
- Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France
| | - Frédéric Bouisset
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Cardiology, Toulouse University Hospital, 31400, Toulouse, France
| | - Julie Herry
- Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France
| | - Yolande Esquirol
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France. .,Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France.
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Gregersen R, Fox Maule C, Husum Bak-Jensen H, Linneberg A, Nielsen OW, Thomsen SF, Meyhoff CS, Dalhoff K, Krogsgaard M, Palm H, Christensen H, Porsbjerg C, Antonsen K, Rungby J, Haugaard SB, Petersen J, Nielsen FE. Profiling Bispebjerg Acute Cohort: Database Formation, Acute Contact Characteristics of a Metropolitan Hospital, and Comparisons to Urban and Rural Hospitals in Denmark. Clin Epidemiol 2022; 14:409-424. [PMID: 35387318 PMCID: PMC8979568 DOI: 10.2147/clep.s338149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark. Patients and Methods We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016–2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types. Results We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9–3.1%], UrC: 3.1% [3.0–3.1%], RuC: 3.4% [3.3–3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3–20.8%], UrC: 17.3% [17.2–17.4%], RuC: 17.5% [17.5–17.6%]). Conclusion Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas.
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Affiliation(s)
- Rasmus Gregersen
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Correspondence: Rasmus Gregersen, Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, 2400, Denmark, Email
| | - Cathrine Fox Maule
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henriette Husum Bak-Jensen
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian S Meyhoff
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Krogsgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedics, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Palm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedics, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kristian Antonsen
- Executive Board, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jørgen Rungby
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Steen B Haugaard
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Janne Petersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn E Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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6
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Tjustrup NC, Engel Schmidt S, Christensen AV, Rasmussen TB, Borregaard B, Thrysoee L, Mols RE, Thorup CB, Juel K, Ankerstjerne A, Berg SK. Patient-reported outcomes, clinical, and demographic variables as predictors of withdrawal from the workforce after hospitalization with heart failure: findings from the national DenHeart survey. Eur J Cardiovasc Nurs 2021; 21:332-340. [PMID: 34499708 DOI: 10.1093/eurjcn/zvab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/11/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022]
Abstract
AIMS Increased prevalence and survival among patients with heart failure draws attention to their everyday life, including their ability to work. Many patients with heart failure withdraw from the workforce, which can affect their quality of life. The aim was to investigate patient-reported outcomes (PROs) and clinical and demographic variables as predictors of withdrawal from the workforce after admission with a diagnose of heart failure. METHODS AND RESULTS Patients with heart failure, who were part of the workforce at admission were included from the national cross-sectional survey, DenHeart. Data were collected from five national heart centres in Denmark, from April 2013 to April 2014. Patient-reported outcomes measured at discharge included SF-12, HeartQoL, HADS, and ESAS. Clinical and demographic variables were obtained from registers, medical records, and index hospitalization. Patient-reported outcomes, clinical, and demographic variables were combined with labour market affiliation 3, 6, 9, and 12 months after admission. The response rate was 49.1% (n = 1517) and of those 364 patients were part of the workforce at index admission. Patients with lower QoL odds ratio (OR) 2.58 [95% confidence interval (CI) 1.24-5.37], symptoms of depression OR 2.57 (95% CI 1.47-4.50) and ejection fraction (EF) ≤35% OR 2.48 (95% CI 1.35-4.56) were more likely to withdraw from the workforce in the first year after admission. Patients with lower symptom burden OR 0.36 (95% CI 0.19-0.68) and a hospital stay of 0-2 days OR 0.18(95% CI 0.08-0.37) were less likely to withdraw. CONCLUSION Low QoL, high symptom burden, symptoms of depression, a longer length of hospital stay, and low EF can predict withdrawal from the workforce in the first year after admission with heart failure.
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Affiliation(s)
- Nina Cecilie Tjustrup
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark
| | - Signe Engel Schmidt
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark
| | - Anne Vingaard Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Trine Bernholdt Rasmussen
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen 1455, Denmark
| | - Anne Ankerstjerne
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Selina Kikkenborg Berg
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen 1455, Denmark
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7
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Jørgensen H, Horváth-Puhó E, Laugesen K, Brækkan S, Hansen JB, Sørensen HT. Risk of a permanent work-related disability pension after incident venous thromboembolism in Denmark: A population-based cohort study. PLoS Med 2021; 18:e1003770. [PMID: 34464405 PMCID: PMC8443033 DOI: 10.1371/journal.pmed.1003770] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/15/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Long-term complications of venous thromboembolism (VTE) hamper physical function and impair quality of life; still, it remains unclear whether VTE is associated with risk of permanent work-related disability. We aimed to assess the association between VTE and the risk of receiving a permanent work-related disability pension and to assess whether this association was explained by comorbidities such as cancer and arterial cardiovascular disease. METHODS AND FINDINGS A Danish nationwide population-based cohort study consisting of 43,769 individuals aged 25 to 66 years with incident VTE during 1995 to 2016 and 218,845 birth year-, sex-, and calendar year-matched individuals from the general population, among whom 45.9% (N = 120,540) were women, was established using Danish national registries. The cohorts were followed throughout 2016, with permanent work-related disability pension as the outcome. Hazard ratios (HRs) with 95% confidence intervals (CIs) for disability pension were computed and stratified by sex and age groups (25 to 34, 35 to 44, 45 to 54, and 55 to 66 years of age) and adjusted for comorbidities and socioeconomic variables. Permanent work-related disability pensions were granted to 4,415 individuals with VTE and 9,237 comparison cohort members (incidence rates = 17.8 and 6.2 per 1,000 person-years, respectively). VTE was associated with a 3-fold (HR 3.0, 95% CI: 2.8 to 3.1) higher risk of receiving a disability pension. Adjustments for socioeconomic status and comorbidities such as cancer and cardiovascular diseases reduced the estimate (HR 2.3, 95% CI: 2.2 to 2.4). The risk of disability pension receipt was slightly higher in men than in women (HR 2.5, 95% CI: 2.3 to 2.6 versus HR 2.1, 95% CI: 2.0 to 2.3). As this study is based on medical and administrative registers, information on post-VTE care, individual health behavior, and workplace factors linked to disability pension in the general population are lacking. Furthermore, as disability pension schemes vary, our results might not be directly generalizable to other countries or time periods. CONCLUSIONS In this study, incident VTE was associated with increased risk of subsequent permanent work-related disability, and this association was still observed after accounting for comorbidities such as cancer and cardiovascular diseases. Our results emphasize the social consequences of VTE and may help occupational and healthcare professionals to identify vulnerable individuals at risk of permanent exclusion from the labor market after a VTE event.
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Affiliation(s)
- Helle Jørgensen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- * E-mail:
| | | | - Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sigrid Brækkan
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Nicolau JC, Furtado RH, Dalçóquio TF, Lara LM, Juliasz MG, Ferrari AG, Nakashima CA, Franci A, Pereira CA, Lima FG, Giraldez RR, Salsoso R, Baracioli LM, Goodman S. Factors associated with actively working in the very long-term following acute coronary syndrome. Clinics (Sao Paulo) 2021; 76:e2553. [PMID: 33503196 PMCID: PMC7811831 DOI: 10.6061/clinics/2021/e2553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Returning to work after an episode of acute coronary syndrome (ACS) is challenging for many patients, and has both personal and social impacts. There are limited data regarding the working status in the very long-term after ACS. METHODS We retrospectively analyzed 1,632 patients who were working prior to hospitalization for ACS in a quaternary hospital and were followed-up for up to 17 years. Adjusted models were developed to analyze the variables independently associated with actively working at the last contact, and a prognostic predictive index for not working at follow-up was developed. RESULTS The following variables were significantly and independently associated with actively working at the last contact: age>median (hazard-ratio [HR], 0.76, p<0.001); male sex (HR, 1.52, p<0.001); government health insurance (HR, 1.36, p<0.001); history of angina (HR, 0.69, p<0.001) or myocardial infarction (MI) (HR, 0.76, p=0.005); smoking (HR, 0.81, p=0.015); ST-elevation MI (HR, 0.81, p=0.021); anterior-wall MI (HR, 0.75, p=0.001); non-primary percutaneous coronary intervention (PCI) (HR, 0.77, p=0.002); fibrinolysis (HR, 0.61, p<0.001); cardiogenic shock (HR, 0.60, p=0.023); statin (HR, 3.01, p<0.001), beta-blocker (HR, 1.26, p=0.020), angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB) (HR, 1.37, p=0.001) at hospital discharge; and MI at follow-up (HR, 0.72, p=0.001). The probability of not working at the last contact ranged from 24.2% for patients with no variables, up to 80% for patients with six or more variables. CONCLUSIONS In patients discharged after ACS, prior and in-hospital clinical variables, as well as the quality of care at discharge, have a great impact on the long-term probability of actively working.
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Affiliation(s)
- Jose C. Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Remo H.M. Furtado
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Talia F. Dalçóquio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Livia M. Lara
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcela G. Juliasz
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Aline G. Ferrari
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos A.K. Nakashima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andre Franci
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cesar A.C. Pereira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Felipe G. Lima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Roberto R. Giraldez
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rocío Salsoso
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciano M. Baracioli
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Shaun Goodman
- Terrence Donnelly Heart Centre, St Michael’s Hospital, University of Toronto, Toronto, Canada
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9
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De Sutter J, Kacenelenbogen R, Pardaens S, Cuypers S, Dendale P, Elegeert I, Cornelissen V, Buys R, Braeckman L, Heyndrickx B, Frederix I. The role of cardiac rehabilitation in vocational reintegration Belgian working group of cardiovascular prevention and rehabilitation position paper. Acta Cardiol 2020; 75:388-397. [PMID: 30893568 DOI: 10.1080/00015385.2019.1570675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cardiovascular disease is one of the main causes of morbidity and sick leave in Belgium, imposing a great socio-economic burden on the contemporary healthcare system and society. Cardiac rehabilitation is an evidence-based treatment strategy that not only improves the cardiac patients' health state but also holds promise so as to facilitate vocational reintegration in the society. This position paper was developed and endorsed by the Belgian Working Group of Cardiovascular Prevention and Rehabilitation. It provides an overview of the currently available Belgian data with regard to the role of cardiac rehabilitation in return to work after an initial cardiac event. It identifies the relevant barriers and facilitators of vocational integration of cardiac patients and summarises the contemporary Belgian legal and medical framework in this regard. Cardiac rehabilitation remains a primordial component of the post-acute event management of the cardiac patient, facilitating vocational reintegrating and thereby decreasing the pressure on social security. Despite the availability of a relevant legislative framework, there is a need for well-defined algorithms to assess readiness for return to work that can be used in daily clinical practice.
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Affiliation(s)
- Johan De Sutter
- Department of Cardiology, AZ Maria Middelares, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Sofie Pardaens
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Heart Center, OLV Aalst, Aalst, Belgium
| | | | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Ivan Elegeert
- Department of Cardiology, Groeninge Hospital, Kortrijk, Belgium
| | | | - Roselien Buys
- Department of Rehabilitation Sciences, KULeuven, Leuven, Belgium
| | - Lutgart Braeckman
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Ines Frederix
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- University Hospital Antwerp (UZA), Edegem, Belgium
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10
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Wilson DM, Errasti-Ibarrondo B, Low G, O'Reilly P, Murphy F, Fahy A, Murphy J. Identifying contemporary early retirement factors and strategies to encourage and enable longer working lives: A scoping review. Int J Older People Nurs 2020; 15:e12313. [PMID: 32166897 DOI: 10.1111/opn.12313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/02/2020] [Indexed: 11/29/2022]
Abstract
AIM Accelerating population ageing is raising concern in many countries now in relation to the availability of workers for essential work roles and responsibilities. A scoping research literature review was done to identify factors currently associated with early retirement and contemporary strategies to encourage and support longer working lives. METHODS Using the PRISMA-ScR Checklist, we searched the Directory of Open Access Journals and EBSCO Discovery Service for published 2013-2018 research articles using the keyword/MeSH term "early retirement"; 54 English-language articles in peer-review journals were reviewed. RESULTS Seven early retirement factors were revealed: Ill health, good health, workplace issues, the work itself, ageism, social norms and having achieved personal financial or pension requirement criteria. Six suggested solutions, none proven effective, were identified: Occupational health programmes, workplace enhancements, work adjustments, addressing ageism, changing social norms and pension changes. CONCLUSIONS The evidence base on early retirement prevention is not strong, with qualitative investigations needed for in-depth understandings of early retirement influences and mixed-methods studies needed to test early retirement prevention solutions for their effects. IMPLICATIONS FOR PRACTICE Until more evidence is available, every organisation should perform an early retirement risk assessment and identify current versus needed policies and programmes to encourage and enable more middle-aged and older people to work longer.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Begoña Errasti-Ibarrondo
- Faculty of Nursing, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Gail Low
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Fiona Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Anne Fahy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Jill Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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11
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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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12
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Garland A, Jeon SH, Stepner M, Rotermann M, Fransoo R, Wunsch H, Scales DC, Iwashyna TJ, Sanmartin C. Effects of cardiovascular and cerebrovascular health events on work and earnings: a population-based retrospective cohort study. CMAJ 2019; 191:E3-E10. [PMID: 30617227 DOI: 10.1503/cmaj.181238] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Survivors of acute health events can experience lasting reductions in functional status and quality of life, as well as reduced ability to work and earn income. We aimed to assess the effect of acute myocardial infarction (MI), cardiac arrest and stroke on work and earning among working-age people. METHODS For this retrospective cohort study, we used the Canadian Hospitalization and Taxation Database, which contains linked hospital and income tax data, from 2005 to 2013 to perform difference-in-difference analyses. We matched patients admitted to hospital for acute MI, cardiac arrest or stroke with controls who were not admitted to hospital for these indications. Participants were aged 40-61 years, worked in the 2 years before the event and were alive 3 years after the event. Patients were matched to controls for 11 variables. The primary outcome was working status 3 years postevent. We also assessed earnings change attributable to the event. We matched 19 129 particpants who were admitted to hospital with acute MI, 1043 with cardiac arrest and 4395 with stroke to 1 820 644, 307 375 and 888 481 controls, respectively. RESULTS Fewer of the patients who were admitted to hospital were working 3 years postevent than controls for acute MI (by 5.0 percentage points [pp], 95% confidence interval [CI] 4.5-5.5), cardiac arrest (by 12.9 pp, 95% CI 10.4-15.3) and stroke (by 19.8 pp, 95% CI 18.5-23.5). Mean (95% CI) earnings declines attributable to the events were $3834 (95% CI 3346-4323) for acute MI, $11 143 (95% CI 8962-13 324) for cardiac arrest, and $13 278 (95% CI 12 301-14 255) for stroke. The effects on income were greater for patients who had lower baseline earnings, comorbid disease, longer hospital length of stay or needed mechanical ventilation. Sex, marital status or self-employment status did not affect income declines. INTERPRETATION Acute MI, cardiac arrest and stroke all resulted in substantial loss in employment and earnings that persisted for at least 3 years after the events. These outcomes have consequences for patients, families, employers and governments. Identification of subgroups at high risk for these losses may assist in targeting interventions, policies and legislation to promote return to work.
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Affiliation(s)
- Allan Garland
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich.
| | - Sung-Hee Jeon
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich
| | - Michael Stepner
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich
| | - Michelle Rotermann
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich
| | - Randy Fransoo
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich
| | - Hannah Wunsch
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich
| | - Damon C Scales
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich
| | - Theodore J Iwashyna
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich
| | - Claudia Sanmartin
- Departments of Medicine and Community Health Sciences (Garland), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Statistics Canada (Jeon, Rotermann, Sanmartin), Ottawa, Ont.; Department of Economics (Stepner), Massachusetts Institute of Technology, Cambridge, Mass.; Manitoba Centre for Health Policy (Fransoo), University of Manitoba Winnipeg, Man.; Interdepartmental Division of Critical Care (Wunsch, Scales), University of Toronto, Toronto, Ont.; Division of Pulmonary and Critical Care Medicine (Iwashyna), University of Michigan, Ann Arbor, Mich
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13
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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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14
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Salzwedel A, Wegscheider K, Schulz-Behrendt C, Dörr G, Reibis R, Völler H. No impact of an extensive social intervention program on return to work and quality of life after acute cardiac event: a cluster-randomized trial in patients with negative occupational prognosis. Int Arch Occup Environ Health 2019; 92:1109-1120. [DOI: 10.1007/s00420-019-01450-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
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15
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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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16
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Salzwedel A, Reibis R, Heidler MD, Wegscheider K, Völler H. Determinants of Return to Work After Multicomponent Cardiac Rehabilitation. Arch Phys Med Rehabil 2019; 100:2399-2402. [PMID: 31054294 DOI: 10.1016/j.apmr.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis. DESIGN Observational, prospective, bicentric. SETTING Postacute 3-week inpatient cardiac rehabilitation (CR). PARTICIPANTS Patients (N=401) <65 years of age (mean 54.5±6.3y), 80% men. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Status of return to work (RTW) 6 months after discharge from CR. RESULTS The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect. CONCLUSIONS The patient's perception and expectation regarding the occupational prognosis play a crucial role in predicting return to work 6 months after an acute cardiac event and CR. These findings highlight the importance of the multimodal approach, in particular psychosocial components, of CR.
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Affiliation(s)
| | - Rona Reibis
- Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam
| | | | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg
| | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam; Klinik am See, Rehabilitation Center for Internal Medicine, Rüdersdorf, Germany
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17
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Stendardo M, Bonci M, Casillo V, Miglio R, Giovannini G, Nardini M, Campo G, Fucili A, Boschetto P. Predicting return to work after acute myocardial infarction: Socio-occupational factors overcome clinical conditions. PLoS One 2018; 13:e0208842. [PMID: 30543689 PMCID: PMC6292571 DOI: 10.1371/journal.pone.0208842] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/25/2018] [Indexed: 12/28/2022] Open
Abstract
Objectives Return to work after acute myocardial infarction (AMI), a leading cause of death globally, is a multidimensional process influenced by clinical, psychological, social and occupational factors, the single impact of which, however, is still not well defined. The objective of this study was to investigate these 4 factors on return to work (RTW) within 365 days after AMI in a homogeneous cohort of patients who had undergone an urgent coronary angioplasty. Participants We studied 102 patients, in employment at the time of AMI (88.24% of men), admitted to the Department of Cardiology of the University-Hospital of Ferrara between March 2015 to December 2016. Demographical and clinical characteristics were obtained from the cardiological records. After completing an interview on social and occupational variables and the Hospital Anxiety and Depression (HADS) questionnaire, patients underwent exercise capacity measurement and spirometry. Results Of the 102 patients, only 12 (12.76%) held a university degree, 68.63% were employees and 31.37% self-employed. The median number of sick-leave days was 44 (IQR 33–88). At day 30, 78.5% of all subjects had not returned to work, at day 60, 40.8% and at day 365 only 7.3% had not resumed working. At univariate analyses, educational degree (p = 0.026), self-employment status (p = 0.0005), white collar professional category (p = 0.020) and HADS depression score were significant for earlier return to work. The multivariate analysis confirms that having a university degree, being self-employed and presenting a lower value of HADS depression score increase the probability of a quicker return to work. Conclusions These findings suggest that the strongest predictors of returning to work within 1 year after discharge for an acute myocardial infarction are related more to socio-occupational than to clinical parameters.
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Affiliation(s)
| | - Melissa Bonci
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Valeria Casillo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Rossella Miglio
- Department of Statistical Sciences "Paolo Fortunati", University of Bologna, Bologna, Italy
| | - Giulia Giovannini
- Department of Statistical Sciences "Paolo Fortunati", University of Bologna, Bologna, Italy
| | - Marco Nardini
- Department of Prevention and Protection, University-Hospital and Public Health Service of Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, University-Hospital of Ferrara, Cona, Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Ravenna, Italy
| | - Alessandro Fucili
- Cardiology Unit, University-Hospital of Ferrara, Cona, Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Ravenna, Italy
| | - Piera Boschetto
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- * E-mail:
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Stevens B, Pezzullo L, Verdian L, Tomlinson J, George A, Bacal F. The Economic Burden of Heart Conditions in Brazil. Arq Bras Cardiol 2018; 111:29-36. [PMID: 30110042 PMCID: PMC6078379 DOI: 10.5935/abc.20180104] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/31/2017] [Indexed: 11/12/2022] Open
Abstract
Background Heart conditions impose physical, social, financial and health-related
quality of life limitations on individuals in Brazil. Objectives This study assessed the economic burden of four main heart conditions in
Brazil: hypertension, heart failure, myocardial infarction, and atrial
fibrillation. In addition, the cost-effectiveness of telemedicine and
structured telephone support for the management of heart failure was
assessed. Methods A standard cost of illness framework was used to assess the costs associated
with the four conditions in 2015. The analysis assessed the prevalence of
the four conditions and, in the case of myocardial infarction, also its
incidence. It further assessed the conditions’ associated expenditures on
healthcare treatment, productivity losses from reduced employment, costs of
providing formal and informal care, and lost
wellbeing. The analysis was informed by a
targeted literature review, data scan and modelling. All inputs and methods
were validated by consulting 15 clinicians and other stakeholders in Brazil.
The cost-effectiveness analysis was based on a meta-analysis and economic
evaluation of post-discharge programs in patients with heart failure,
assessed from the perspective of the Brazilian Unified Healthcare System
(Sistema Unico de Saude). Results Myocardial infarction imposes the greatest financial cost (22.4 billion
reais/6.9 billion USD), followed by heart failure (22.1 billion reais/6.8
billion USD), hypertension (8 billion reais/2.5 billion USD) and, finally,
atrial fibrillation (3.9 billion reais/1.2 billion USD). Telemedicine and
structured telephone support are cost-effective interventions for achieving
improvements in the management of heart failure. Conclusions Heart conditions impose substantial loss of wellbeing and financial costs in
Brazil and should be a public health priority.
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Affiliation(s)
| | | | | | | | | | - Fernando Bacal
- Instituto do Coração (InCor) - HC-Faculdade de Medicina da USP, São Paulo, SP - Brazil
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19
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Gragnano A, Negrini A, Miglioretti M, Corbière M. Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:215-231. [PMID: 28589524 DOI: 10.1007/s10926-017-9714-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Purpose This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.
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Affiliation(s)
- Andrea Gragnano
- Institut de recherche Robert-Sauvé en santé et en Sécurité du travail, 505 boul. de Maisonneuve Ouest, Montreal, QC, H3A 3C2, Canada.
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada.
- Department of Education, Career Counselling, Université du Québec à Montréal (UQAM), Montreal, QC, Canada.
| | - Alessia Negrini
- Institut de recherche Robert-Sauvé en santé et en Sécurité du travail, 505 boul. de Maisonneuve Ouest, Montreal, QC, H3A 3C2, Canada
| | | | - Marc Corbière
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
- Department of Education, Career Counselling, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
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Ervasti J, Virtanen M, Lallukka T, Friberg E, Mittendorfer-Rutz E, Lundström E, Alexanderson K. Trends in diagnosis-specific work disability before and after ischaemic heart disease: a nationwide population-based cohort study in Sweden. BMJ Open 2018; 8:e019749. [PMID: 29674367 PMCID: PMC5914777 DOI: 10.1136/bmjopen-2017-019749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We examined trends of diagnosis-specific work disability before and after ischaemic heart disease (IHD). DESIGN Participants were followed 4 years before and 4 years after an IHD event for diagnosis-specific work disability (sickness absence and disability pension). SETTING AND PARTICIPANTS A Swedish population-based cohort study using register data on all individuals aged 25-60 years, living in Sweden, and who suffered their first IHD event in 2006-2008 (n=23 971) was conducted. RESULTS Before the event, the most common diagnoses of work disability were musculoskeletal disorders (21 annual days for men and 44 for women) and mental disorders (19 men and 31 for women). After multivariable adjustments, we observed a fivefold increase (from 12 to 60 days) in work disability due to diseases of the circulatory system in the first postevent year compared with the last pre-event year among men. Among women, the corresponding increase was fourfold (from 14 to 62 days). By the second postevent year, the number of work disability days decreased significantly compared with the first postevent year among both sexes (to 19 days among men and 23 days among women). Among women, mean days of work disability due to diseases of the circulatory system remained at a higher level than among men during the postevent years. Work disability risk after versus before an IHD event was slightly higher among men (rate ratio (RR) 2.49; 95% CI 2.36 to 2.62) than among women (RR 2.29, 95% CI 2.12 to 2.49). When pre-event long-term work disability was excluded, diseases of the circulatory system were the most prevalent diagnosis for work disability after an IHD event among both men and women. CONCLUSIONS An IHD event was strongly associated with an increase in work disability due to diseases of the circulatory system, especially among men and particularly in the first postevent year.
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Affiliation(s)
- Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marianna Virtanen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Lundström
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Stevens B, Pezzullo L, Verdian L, Tomlinson J, Estrada-Aguilar C, George A, Verdejo-París J. The economic burden of hypertension, heart failure, myocardial infarction, and atrial fibrillation in Mexico. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:241-244. [PMID: 29655621 DOI: 10.1016/j.acmx.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- Bryce Stevens
- Health Economics and Social Policy, Deloitte Access Economics Pty Ltd, Canberra, Australia
| | - Lynne Pezzullo
- Health Economics and Social Policy, Deloitte Access Economics Pty Ltd, Canberra, Australia
| | - Lara Verdian
- Health Economics and Social Policy, Deloitte Access Economics Pty Ltd, Canberra, Australia
| | - Josh Tomlinson
- Health Economics and Social Policy, Deloitte Access Economics Pty Ltd, Canberra, Australia
| | | | - Alice George
- Health Economics and Social Policy, Deloitte Access Economics Pty Ltd, Canberra, Australia.
| | - Juan Verdejo-París
- Dirección de Enseñanza, Instituto Nacional de Cardiología, Mexico City, Mexico
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Weather and risk of ST-elevation myocardial infarction revisited: Impact on young women. PLoS One 2018; 13:e0195602. [PMID: 29630673 PMCID: PMC5891074 DOI: 10.1371/journal.pone.0195602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background During the last decade, the incidence and mortality rates of ST-elevation myocardial infarction (STEMI) has been steadily increasing in young women but not in men. Environmental variables that contribute to cardiovascular events in women remain ill-defined. Methods and results A total of 2199 consecutive patients presenting with acute ST-elevation myocardial infarction (STEMI, 25.8% women, mean age 62.6±12.4 years) were admitted at the Montreal Heart Institute between June 2010 and December 2014. Snow fall exceeding 2cm/day was identified as a positive predictor for STEMI admission rates in the overall population (RR 1.28, 95% CI 1.07–1.48, p = 0.005), with a significant effect being seen in men (RR 1.30, 95% CI 1.06–1.53, p = 0.01) but not in women (p = NS). An age-specific analysis revealed a significant increase in hospital admission rates for STEMI in younger women ≤55 years, (n = 104) during days with higher outside temperature (p = 0.004 vs men ≤55 years) and longer daylight hours (p = 0.0009 vs men ≤55 years). Accordingly, summer season, increased outside temperature and sunshine hours were identified as strong positive predictors for STEMI occurrence in women ≤55 years (RR 1.66, 95% CI 1.1–2.5, p = 0.012, RR 1.70, 95% CI 1.2–2.5, p = 0.007, and RR 1.67, 95% CI 1.2–2.5, p = 0.011, respectively), while an opposite trend was observed in men ≤55 years (RR for outside temperature 0.8, 95% CI 0.73–0.95, p = 0.01). Conclusion The impact of environmental variables on STEMI is age- and sex-dependent. Higher temperature may play an important role in triggering such acute events in young women.
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Funder KS, Rasmussen LS, Siersma V, Lohse N, Hesselfeldt R, Pedersen F, Hendriksen OM, Steinmetz J. Helicopter vs. ground transportation of patients bound for primary percutaneous coronary intervention. Acta Anaesthesiol Scand 2018; 62:568-578. [PMID: 29484640 PMCID: PMC5888124 DOI: 10.1111/aas.13092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Implementation of the first Danish helicopter emergency medical service (HEMS) was associated with reduced time from first medical contact to treatment at a specialized centre for patients with suspected ST elevation myocardial infarction (STEMI). We aimed to investigate effects of HEMS on mortality and labour market affiliation in patients admitted for primary percutaneous coronary intervention (PCI). METHODS In this prospective observational study, we included patients with suspected STEMI within the region covered by the HEMS from January 1, 2010, to April 30, 2013, transported by either HEMS or ground emergency medical services (GEMS) to the regional PCI centre. The primary outcome was 30-day mortality. RESULTS Among the 384 HEMS and 1220 GEMS patients, time from diagnostic ECG to PCI centre arrival was lower with HEMS (median 71 min vs. 78 min with GEMS; P = 0.004). Thirty-day mortality was 5.0% and 6.2%, respectively (adjusted OR = 0.82, 95% CI 0.44-1.51, P = 0.52. Involuntary early retirement rates were 0.62 (HEMS) and 0.94 (GEMS) per 100 PYR (adjusted IRR = 0.68, 0.15-3.23, P = 0.63). The proportion of patients on social transfer payments longer than half of the follow-up time was 22.1% (HEMS) vs. 21.2% (adjusted OR = 1.10, 0.64-1.90, P = 0.73). CONCLUSION In an observational study of patients with suspected STEMI in eastern Denmark, no significant beneficial effect of helicopter transport could be detected on mortality, premature labour market exit or work ability. Only a study with random allocation to one system vs. another, along with a large sample size, will allow determination of superiority of helicopter transport.
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Affiliation(s)
- K. S. Funder
- Department of Anaesthesia; Centre of Head and Orthopaedics 4231; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - L. S. Rasmussen
- Department of Anaesthesia; Centre of Head and Orthopaedics 4231; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - V. Siersma
- The Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - N. Lohse
- Department of Anaesthesia; Centre of Head and Orthopaedics 4231; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - R. Hesselfeldt
- Department of Anaesthesia; Centre of Head and Orthopaedics 4231; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - F. Pedersen
- Department of Cardiology; The Heart Centre; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | | | - J. Steinmetz
- Emergency Medical Services Copenhagen; University of Copenhagen; Ballerup Denmark
- National Helicopter Emergency Medical Services; Aarhus Denmark
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Ali L, Fors A, Ekman I. Need of support in people with chronic obstructive pulmonary disease. J Clin Nurs 2018; 27:e1089-e1096. [PMID: 29149463 PMCID: PMC5900916 DOI: 10.1111/jocn.14170] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 12/29/2022]
Abstract
AIM AND OBJECTIVE The aim of this study was to describe peoples' experiences and expectations of support when living with chronic obstructive pulmonary disease. METHOD We conducted and analysed face-to-face or telephone interviews with 17 individuals (aged 44-77 years) diagnosed with chronic obstructive pulmonary disease. The interviewer asked open-ended questions aimed at encouraging further narration, and we analysed the participants' narratives using a phenomenological hermeneutical approach. This report adheres to the COREQ guidelines. RESULTS The overall theme suggests that people with chronic obstructive pulmonary disease describe support as shared knowledge and experiences, based on the following subthemes; similar experiences, the need of genuine professional knowledge, self-reliance versus self-blame, and the Internet - feeling safe but uncertain. CONCLUSIONS People with chronic obstructive pulmonary disease find their strength through shared knowledge and dialogical support with others who have similar experiences and with professionals. A person-centred eHealth approach may be suitable for this group as it offers both collaboration and support. RELEVANCE TO CLINICAL PRACTICE There is a demand for access to genuine professional knowledge as additional support to patients' own capabilities and needs. Patient associations were assessed as reliable sources of information and to some extent also support, but the importance of access to professional sources was also stressed.
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Affiliation(s)
- Lilas Ali
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
| | - Andreas Fors
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Närhälsan Research and DevelopmentPrimary Health CareRegion Västra GötalandGothenburgSweden
| | - Inger Ekman
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
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Topa G, Depolo M, Alcover CM. Early Retirement: A Meta-Analysis of Its Antecedent and Subsequent Correlates. Front Psychol 2018; 8:2157. [PMID: 29354075 PMCID: PMC5759094 DOI: 10.3389/fpsyg.2017.02157] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/28/2017] [Indexed: 01/01/2023] Open
Abstract
Early or voluntary retirement (ER) can be defined as the full exit from an organizational job or career path of long duration, decided by individuals of a certain age at the mid or late career before mandatory retirement age, with the aim of reducing their attachment to work and closing a process of gradual psychological disengagement from working life. Given the swinging movements that characterize employment policies, the potential effects of ER-both for individuals and society-are still controversial. This meta-analysis examined the relationships between ER and its antecedent and subsequent correlates. Our review of the literature was generated with 151 empirical studies, containing a total number of 706,937 participants, with a wide range of sample sizes (from N = 27 to N = 127,384 participants) and 380 independent effect sizes (ESs), which included 171 independent samples. A negligible ES value for antecedent correlates of early retirement (family pull, job stress, job satisfaction, and income) was obtained (which ranged from r = -0.13 to 0.19), while a fair ES was obtained for workplace timing for retirement, organizational pressures, financial security, and poor physical and mental health, (ranging from r = 0.28 to 0.25). Regarding ER subsequent correlates, poor ESs were obtained, ranging from r = 0.08 to 0.18 for the relationships with subsequent correlates, and fair ESs only for social engagement (r = -0.25). Examination of the potential moderator variables has been conducted. Only a reduced percentage of variability of primary studies has been explained by moderators. Although potential moderator factors were examined, there are several unknown or not measurable factors which contribute to ER and about which there are very little data available. The discussion is aimed to offer theoretical and empirical implications suggestion in order to improve employee's well-being.
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Affiliation(s)
- Gabriela Topa
- Social and Organizational Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Marco Depolo
- Psychology, Università di Bologna, Bologna, Italy
| | - Carlos-Maria Alcover
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Immunology and Medical Microbiology, Nursing, and Stomatology, Universidad Rey Juan Carlos, Madrid, Spain
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Smedegaard L, Numé AK, Charlot M, Kragholm K, Gislason G, Hansen PR. Return to Work and Risk of Subsequent Detachment From Employment After Myocardial Infarction: Insights From Danish Nationwide Registries. J Am Heart Assoc 2017; 6:e006486. [PMID: 28978528 PMCID: PMC5721858 DOI: 10.1161/jaha.117.006486] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Limited data are available on return to work and subsequent detachment from employment after admission for myocardial infarction (MI). METHODS AND RESULTS Using individual-level linkage of data from nationwide registries, we identified patients of working age (30-65 years) discharged after first-time MI in the period 1997 to 2012, who were employed before admission. To assess the cumulative incidence of return to work and detachment from employment, the Aalen Johansen estimator was used. Incidences were compared with population controls matched on age and sex. Logistic regression was applied to estimate odds ratios for associations between detachment from employment and age, sex, comorbidities, income, and education level. Of 39 296 patients of working age discharged after first-time MI, 22 394 (56.9%) were employed before admission. Within 1 year 91.1% (95% confidence interval [CI], 90.7%-91.5%) of subjects had returned to work, but 1 year after their return 24.2% (95% CI, 23.6%-24.8%) were detached from employment and received social benefits. Detachment rates were highest in patients aged 60 to 65 and 30 to 39 years, and significantly higher in patients with MI compared with population controls. Predictors of detachment were heart failure (odds ratio 1.20 [95% CI, 1.08-1.34]), diabetes mellitus (odds ratio 1.13 [95% CI, 1.01-1.25]), and depression (odds ratio 1.77 [95% CI, 1.55-2.01]). High education level and high income favored continued employment. CONCLUSIONS Despite that most patients returned to work after first-time MI, about 1 in 4 was detached from employment after 1 year. Several factors including age and lower socioeconomic status were associated with risk of detachment from employment.
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Affiliation(s)
- Laerke Smedegaard
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
| | - Anna-Karin Numé
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
| | - Mette Charlot
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
| | - Kristian Kragholm
- Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
- The Institute of Public Health University of Southern Denmark, Copenhagen, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Peter R Hansen
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Denmark
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O'Hagan F. Work, organisational practices, and margin of manoeuver during work reintegration. Disabil Rehabil 2017; 41:172-181. [PMID: 28960114 DOI: 10.1080/09638288.2017.1383520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many individuals of working age experience cardiovascular disease and are disabled from work as a result. The majority of research in cardiac work disability has focused on individual biological and psychological factors influencing work disability despite evidence of the importance of social context in work disability. In this article, the focus is on work and organisational features influencing the leeway (margin of manoeuvre) workers are afforded during work reintegration. METHODS A qualitative method was used. A large auto manufacturing plant was selected owing to work, organisational, and worker characteristics. Workplace context was assessed through site visits and meetings with stakeholders including occupational health, human resources and union personnel and a review of collective agreement provisions relating to seniority, benefits and accommodation. Worker experience was assessed using a series of in-depth interviews with workers (n = 12) returning to work at the plant following disabling cardiac illness. Data was analysed using qualitative content analysis. RESULTS Workers demonstrated variable levels of adjustment to the workplace that could be related to production expectations and work design. Policies and practices around electronic rate monitoring, seniority and accommodation, and disability management practices affected the buffer available to workers to adjust to the workplace. CONCLUSIONS Work qualities and organisational resources establish a margin of manoeuver for work reintegration efforts. Practitioners need to inform themselves of the constraints on work accommodation imposed by work organisation and collective agreements. Organisations and labour need to reconsider policies and practices that creates unequal accommodation conditions for disabled workers. Implications for rehabilitation Margin of manoeuvre offers a framework for evaluating and structuring work reintegration programmes. Assessing initial conditions for productivity expectations, context and ways and means to support work reintegration can be integrated with worker perceptions of work ability and possibilities for adaptation to structure and then monitor work reintegration programmes. Margin of manoeuvre can be used to evaluate sustainability of work at the end of rehabilitation. Cause-based workers' compensation schemes, collective agreement provisions, and organisational approaches to non-compensable disability create two tiers of disabled workers and make certain workers more vulnerable to occupational disability.
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Affiliation(s)
- Fergal O'Hagan
- a Department of Psychology , Trent University , Peterborough , Canada
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Ervasti J, Virtanen M, Lallukka T, Friberg E, Mittendorfer-Rutz E, Lundström E, Alexanderson K. Permanent work disability before and after ischaemic heart disease or stroke event: a nationwide population-based cohort study in Sweden. BMJ Open 2017; 7:e017910. [PMID: 28965101 PMCID: PMC5640121 DOI: 10.1136/bmjopen-2017-017910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We examined the risk of disability pension before and after ischaemic heart disease (IHD) or stroke event, the burden of stroke compared with IHD and which factors predicted disability pension after either event. DESIGN A population-based cohort study with follow-up 5 years before and after the event. Register data were analysed with general linear modelling with binary and Poisson distributions including interaction tests for event type (IHD/stroke). SETTING AND PARTICIPANTS All people living in Sweden, aged 25‒60 years at the first event year, who had been living in Sweden for 5 years before the event and had no indication of IHD or stroke prior to the index event in 2006‒2008 were included, except for cases in which death occurred within 30 days of the event. People with both IHD and stroke were excluded, resulting in 18 480 cases of IHD (65%) and 9750 stroke cases (35%). PRIMARY OUTCOME MEASURES Disability pension. RESULTS Of those going to suffer IHD or stroke event, 25% were already on disability pension a year before the event. The adjusted OR for disability pension at first postevent year was 2.64-fold (95% CI 2.25 to 3.11) for people with stroke compared with IHD. Economic inactivity predicted disability pension regardless of event type (OR=3.40; 95% CI 2.85 to 4.04). Comorbid mental disorder was associated with the greatest risk (OR=3.60; 95% CI 2.69 to 4.83) after an IHD event. Regarding stroke, medical procedure, a proxy for event severity, was the largest contributor (OR=2.27, 95% CI 1.43 to 3.60). CONCLUSIONS While IHD event was more common, stroke involved more permanent work disability. Demographic, socioeconomic and comorbidity-related factors were associated with disability pension both before and after the event. The results help occupational and other healthcare professionals to identify vulnerable groups at risk for permanent labour market exclusion after such an event.
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Affiliation(s)
- Jenni Ervasti
- Research and Service Centre of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marianna Virtanen
- Research and Service Centre of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tea Lallukka
- Research and Service Centre of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Lundström
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Merritt CJ, de Zoysa N, Hutton JM. A qualitative study of younger men's experience of heart attack (myocardial infarction). Br J Health Psychol 2017; 22:589-608. [PMID: 28544174 DOI: 10.1111/bjhp.12249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/14/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The effects of heart attack, or myocardial infarction (MI), across psychosocial domains may be particularly acute in younger adults, for whom serious health events are non-normative. MI morbidity is declining in Western countries, but in England MI numbers have plateaued for the under-45 cohort, where approximately 90% of patients are male. Qualitative research on younger adults' experience of MI is limited, and no study has sampled exclusively under-45s. This study aimed to understand how a sample of men under 45 adjusted to and made sense of MI. DESIGN Qualitative research design based on semi-structured in-depth interviews. METHODS Ten men aged under 45 who had experienced MI in the past 3-6 months were purposively recruited and interviewed. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. RESULTS Seven superordinate themes were identified. This article focuses in depth on the three most original themes: (1) 'I'm less of a man', which described experiences of losing 'maleness' (strength, independence, ability to provide) post-MI; (2) 'Shortened horizons', which covered participants' sense of foreshortened future and consequent reprioritization; and (3) 'Life loses its colour', describing the loss of pleasure from lifestyle-related changes. CONCLUSION Themes broadly overlapped with the qualitative literature on younger adult MI. However, some themes (e.g., loss of 'maleness' post-MI, and ambivalence towards MI risk factors) appeared unique to this study. Themes were also discussed in relation to risk factors for anxiety and depression and how this might inform clinical care for a younger, male population. Statement of contribution What is already known on this subject? Myocardial infarction (MI) morbidity is not declining in England for under-45s. Adjustment to MI is particularly challenging for younger adults, perhaps because it is non-normative. However, little is known about the experience of MI in younger adults. What does this study add? This is the first qualitative study to sample MI patients exclusively under 45, thereby mapping to epidemiological trends. Further support is provided for some themes identified in the existing young adult MI literature. New themes are identified here which can provide insights relevant to clinical care in this population.
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Affiliation(s)
| | - Nicole de Zoysa
- South London and Maudsley NHS Foundation Trust and King's College Hospital NHS Foundation Trust, London, UK
| | - Jane M Hutton
- South London and Maudsley NHS Foundation Trust and King's College Hospital NHS Foundation Trust, London, UK
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Virtanen M, Ervasti J, Mittendorfer-Rutz E, Lallukka T, Kjeldgård L, Friberg E, Kivimäki M, Lundström E, Alexanderson K. Work disability before and after a major cardiovascular event: a ten-year study using nationwide medical and insurance registers. Sci Rep 2017; 7:1142. [PMID: 28442715 PMCID: PMC5430721 DOI: 10.1038/s41598-017-01216-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/24/2017] [Indexed: 02/07/2023] Open
Abstract
We examined the trajectories of work disability before and after IHD and stroke events. New IHD (n = 13521) and stroke (n = 7162) cases in 2006–2008 were retrieved from nationwide Swedish hospital records and their annual work disability days five years before and after the date of diagnosis were retrieved from a nationwide disability register. There was no pre-event differences in disability days between the IHD and stroke cases and five years prior to the event, they were close to those observed in the general population. In the first post-event year, the adjusted mean days increased to 83.9 (95% CI 80.6–86.5) in IHD; to 179.5 (95% CI 172.4–186.8) in stroke, a six-fold increase in IHD and 14-fold in stroke. Work disability leveled off among the IHD cases but not among those who had stroke. The highest disability levels for the fifth post-event year after a stroke event was associated with pre-existing diabetes (146.9), mental disorder (141.2), non-employment (137.0), and immigrant status (117.9). In a working-age population, the increase in work disability after a cardiovascular event decreases close to the pre-event level in IHD but remains particularly high after stroke; among patients with comorbid depression or diabetes, immigrants, and those not in employment.
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Affiliation(s)
- Marianna Virtanen
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251, Helsinki, Finland.
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251, Helsinki, Finland
| | - Ellenor Mittendorfer-Rutz
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77, Stockholm, Sweden
| | - Tea Lallukka
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251, Helsinki, Finland.,Department of Public Health, University of Helsinki, Clinicum, P.O. Box 63, FI-00014, Helsinki, Finland
| | - Linnea Kjeldgård
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77, Stockholm, Sweden
| | - Emilie Friberg
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251, Helsinki, Finland.,Department of Public Health, University of Helsinki, Clinicum, P.O. Box 63, FI-00014, Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Erik Lundström
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Neurology, SE-171 77, Stockholm, Sweden
| | - Kristina Alexanderson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77, Stockholm, Sweden
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Virtanen M, Lallukka T, Ervasti J, Rahkonen O, Lahelma E, Pentti J, Pietiläinen O, Vahtera J, Kivimäki M. The joint contribution of cardiovascular disease and socioeconomic status to disability retirement: A register linkage study. Int J Cardiol 2016; 230:222-227. [PMID: 28063665 DOI: 10.1016/j.ijcard.2016.12.166] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/23/2016] [Accepted: 12/25/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Whether low occupational class amplifies the risk of disability retirement among employees with cardiovascular disease (CVD) is unknown. We examined this issue in two prospective cohort studies. METHODS In the Finnish Public Sector Study and the Helsinki Health Study (n=50.799 employees), prevalent CVD (coronary heart disease or stroke, n=1269) was ascertained using records from national health registers, self-reported doctor-diagnosed diseases, and Rose Angina Questionnaire. Data linkage to national pension registers allowed the follow up of disability retirement among the participants for a mean of six years. We analysed the associations of occupational class and CVD with disability retirement using Cox regression, tested interactions between occupational class and prevalent CVD in predicting disability retirement by calculating the Synergy Index, and pooled the results from the two studies using fixed-effect meta-analysis. RESULTS Compared with the participants from high occupational class and no CVD, the participants from the low occupational class without CVD had a 2.13-fold (95% CI 1.97-2.30), those with high occupational class and CVD a 2.18-fold (1.73-2.74); and those with both low occupational class and CVD a 4.49-fold (3.83-5.26) risk of disability retirement. A Synergy Index of 1.55 (1.16-2.06) suggested a greater than additive effect for low occupational class and CVD in combination. CONCLUSIONS Individuals with both low occupational class and CVD are at a particularly high risk of premature exit from the labour market due to work disability. These findings suggest that better preventive strategies are needed to improve prognosis in this risk group.
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Affiliation(s)
| | - Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Helsinki, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Finland
| | - Jaana Pentti
- Finnish Institute of Occupational Health, Turku, Finland
| | | | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK
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Employment Status and Sick Leave After First-Time Implantable Cardioverter Defibrillator Implantation: Results From the COPE-ICD Trial. J Cardiovasc Nurs 2016; 32:448-454. [PMID: 27631118 DOI: 10.1097/jcn.0000000000000366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the Copenhagen Outpatient Programme-Implantable Cardioverter Defibrillator (COPE-ICD) Trial, a positive effect from a cost-saving, comprehensive cardiac rehabilitation program was found on physical and mental health in patients with ICDs. OBJECTIVE In the context of the COPE-ICD Trial, the aims of this study is to investigate (a) employment status after ICD implantation, (b) the number of sick days related to ICD implantation, (c) differences in employment status and sick days between rehabilitation and usual care groups, and (d) predictors of employment status and sick leave. METHOD Patients with first-time ICD implantation were randomized to comprehensive cardiac rehabilitation or usual care. One year after ICD implantation, patients answered questions about employment status and sick leave. Differences were tested using the Student t test and the χ test. Predictors of employment status and sick leave were tested using logistic regression and linear regression models. RESULT A total of 196 patients were randomized. The questionnaire was completed by 138 patients (70%). In total, 47% had worked before ICD implantation. After 1 year, 81% were still working and their mean (SD) number of sick days was 33.8 (58.3). Age 60 years or younger and secondary ICD indication were predictors of working after 1 year. Patients with secondary ICD indication had more sick days and patients who were not married had fewer sick days. CONCLUSION Most patients who worked before ICD implantation returned to work after the ICD was placed. Those who were married and had an ICD for secondary prevention took more sick days after the ICD than did those without these characteristics. Those who were younger and have a secondary indication ICD were more likely to be working 1 year after ICD implantation.
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Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: Subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016; 221:957-62. [PMID: 27441475 DOI: 10.1016/j.ijcard.2016.07.060] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to evaluate the effects of person-centred care (PCC) after acute coronary syndrome (ACS) in relation to educational level of participants. METHOD 199 Patients <75years with ACS were randomised to PCC plus usual care or usual care alone and followed for 6months from hospital to outpatient care and primary care. For the PCC group, patients and health care professionals co-created a PCC health plan reflecting both perspectives, which induced a continued collaboration in person-centred teams at each health care level. A composite score of changes that included general self-efficacy assessment, return to work or previous activity level, re-hospitalisation or death was used as outcome measure. RESULTS In the group of patients without postsecondary education (n=90) the composite score showed a significant improvement in favour of the PCC intervention (n=40) vs. usual care (n=50) at six months (35.0%, n=14 vs. 16.0%, n=8; odds ratio (OR)=2.8, 95% confidence interval (CI): 1.0-7.7, P=0.041). In patients with postsecondary education (n=109), a non-significant difference in favour of the PCC intervention (n=54) vs. usual care (n=55) was observed in the composite score (13.0%, n=7 vs 3.6%, n=2; OR=3.9, 95% CI: 0.8-19.9, P=0.097). CONCLUSION A PCC approach, which stresses the necessity of a patient-health care professional partnership, is beneficial in patients with low education after an ACS event. Because these patients have been identified as a vulnerable group in cardiac rehabilitation, we suggest that PCC can be integrated into conventional cardiac rehabilitation programmes to improve both equity in uptake and health outcomes. TRIAL REGISTRATION Swedish registry, Researchweb.org, ID NR 65 791.
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Affiliation(s)
- Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. http://www.gpcc.gu.se
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; National Heart and Lung Institute, Imperial College, London, United Kingdom. http://www.gpcc.gu.se
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden. http://www.gpcc.gu.se
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Psychosocial job conditions, fear avoidance beliefs and expected return to work following acute coronary syndrome: a cross-sectional study of fear-avoidance as a potential mediator. BMC Public Health 2015; 15:1263. [PMID: 26689711 PMCID: PMC4687316 DOI: 10.1186/s12889-015-2599-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022] Open
Abstract
Background Despite improvements in treatment, acute coronary syndrome remains a substantial cause for prolonged sick absences and premature retirement. Knowledge regarding what benefits return to work is limited, especially the effect of psychological processes and psychosocial work factors. The purposes of this cross-sectional study were two-fold: to examine associations between adverse psychosocial job conditions and fear-avoidance beliefs towards work, and to determine whether such beliefs mediated the relationship between work conditions and expected return to work in acute coronary syndrome survivors. Methods Study inclusion criteria: acute myocardial infarction or unstable angina diagnosis, below 65 years of age, being a resident in the West county of Sweden and currently working. In all, 509 individuals (21.8 % women) accepted study participation and for whom all data of study interest were available for analysis. Psychosocial work variables; job demand-control and effort-reward imbalance, were assessed with standard questionnaire batteries. Linear regression models were used to investigate relationships between psychosocial factors and fear-avoidance, and to evaluate mediator effects for fear-avoidance. Both total sample and gender stratified analyses were calculated. Results Fear-avoidance beliefs about work were associated to psychosocial job environments characterized by high strain (β 1.4; CI 1.2–1.6), active and passive work and high effort-reward imbalance (β 0.6; CI 0.5–0.7). Further, such beliefs also mediated the relationship between adverse work conditions and expected time for return to work. However, these results were only observed in total sample analyses or among or male participants. For women only high strain was linked to fear-avoidance, and these relationships became non-significant when entering chosen confounders. Conclusions This cross-sectional study showed that acute coronary syndrome survivors, who laboured under adverse psychosocial work conditions, held fear-avoidance beliefs towards their workplace. Furthermore, these beliefs mediated the relationships between - high strained or high effort-reward imbalanced work - and expected return to work. However, mentioned results were primarily found among men, which could results from few female study participants or gender differences in return to work mechanisms. Still, an earlier return to work might be promoted by interventions focusing on improved psychosocial work conditions and cognitive behavioural therapy targeting fear-avoidance beliefs.
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Chaker L, Falla A, van der Lee SJ, Muka T, Imo D, Jaspers L, Colpani V, Mendis S, Chowdhury R, Bramer WM, Pazoki R, Franco OH. The global impact of non-communicable diseases on macro-economic productivity: a systematic review. Eur J Epidemiol 2015; 30:357-95. [PMID: 25837965 PMCID: PMC4457808 DOI: 10.1007/s10654-015-0026-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/24/2015] [Indexed: 12/23/2022]
Abstract
Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.
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Affiliation(s)
- Layal Chaker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Person-centred care after acute coronary syndrome, from hospital to primary care - A randomised controlled trial. Int J Cardiol 2015; 187:693-9. [PMID: 25919754 DOI: 10.1016/j.ijcard.2015.03.336] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 12/17/2022]
Abstract
AIM To evaluate if person-centred care can improve self-efficacy and facilitate return to work or prior activity level in patients after an event of acute coronary syndrome. METHOD 199 patients with acute coronary syndrome < 75 years were randomly assigned to person-centred care intervention or treatment as usual and followed for 6 months. In the intervention group a person-centred care process was added to treatment as usual, emphasising the patient as a partner in care. Care was co-created in collaboration between patients, physicians, registered nurses and other health care professionals and documented in a health plan. A team-based partnership across three health care levels included transparent knowledge about the disease and medical state to achieve agreed goals during recovery. Main outcome measure was a composite score of changes in general self-efficacy ≥ 5 units, return to work or prior activity level and re-hospitalisation or death. RESULTS The composite score showed that more patients (22.3%, n=21) improved in the intervention group at 6 months compared to the control group (9.5%, n=10) (odds ratio, 2.7; 95% confidence interval: 1.2-6.2; P=0.015). The effect was driven by improved self-efficacy ≥ 5 units in the intervention group. Overall general self-efficacy improved significantly more in the intervention group compared with the control group (P=0.026). There was no difference between groups on re-hospitalisation or death, return to work or prior activity level. CONCLUSION A person-centred care approach emphasising the partnership between patients and health care professionals throughout the care chain improves general self-efficacy without causing worsening clinical events.
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Stavroulakis K, Donas KP, Torsello G, Osada N, Schönefeld E. Gender-Related Long-term Outcome of Primary Femoropopliteal Stent Placement for Peripheral Artery Disease. J Endovasc Ther 2015; 22:31-7. [DOI: 10.1177/1526602814564382] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate gender-related long-term outcomes in patients undergoing stent treatment of femoropopliteal peripheral artery disease. Methods: Between September 2006 and August 2010, all 517 patients (333 men and 184 women; mean age 70.6 years) undergoing primary stent placement in femoropopliteal atherosclerotic lesions at 2 European vascular centers were prospectively enrolled in the study. The main study outcome was primary stent patency. Secondary outcomes included secondary patency, limb salvage, and all-cause mortality. Results: Women had a higher incidence of critical limb ischemia (32.1% vs. 16.9%, p<0.001). Lesion characteristics according to the TransAtlantic Inter-Society Consensus (TASC) classification were comparable in both genders (p=0.52), although total occlusions and popliteal involvement were observed more frequently in female patients (p=0.043 and p=0.001, respectively). Both genders showed similar 5-year primary patency rates (64.3% men vs. 58.1% women, p=0.11). A statistically significant difference was observed concerning the secondary patency rates in favor of men (71.9% vs. 66.8% at 5 years, p=0.005). Limb salvage rates did not vary between the groups (p=0.83). Survival rates were comparable at 5 years (83.3% and 82.6% for men and women, respectively; p=0.63), although female patients were older at their presentation (68.5 vs. 74.3 years, p<0.001). Female gender was an independent risk factor for restenosis for TASC C/D lesions (primary patency rate 39.8% in women vs. 62.0% in men; p=0.002). Finally, critical limb ischemia was an independent risk factor for restenosis in women (odds ratio 1.5). Conclusion: Female gender was associated with a higher prevalence of critical limb ischemia, poorer secondary patency, and more frequent restenosis in TASC C/D lesions. Endovascular treatment of femoropopliteal lesions provides equal results between genders in terms of primary stent patency in the long term.
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Affiliation(s)
- Konstantinos Stavroulakis
- Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Konstantinos P. Donas
- Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Nani Osada
- Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Eva Schönefeld
- Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
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