Abstract
BackgroundAlthough coronary revascularisation by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are common procedures, little is known regarding disability pension (DP) at the time of coronary revascularisation and its association with mortality. The aim was to investigate the five-year mortality following a first coronary revascularisation among women and men on DP, compared with those not on DP at the time of intervention, accounting for socio-demographic and medical factors.Material and MethodsA nationwide prospective population-based cohort study was conducted, using national registers including 70,040 patients (80% men), aged 30–64 years, with a first CABG (n = 24,987; 36%) or PCI (n = 45,053; 64%) during 1994–2006 in Sweden, who were alive 30 days after the intervention. The main outcome was all-cause and cause-specific mortality within five years or through 31 December 2006, following CABG and PCI, and the exposure was DP at the time of a first coronary revascularisation. Information on DP, patient characteristics, date and cause of death was obtained from nationwide registers. Hazard ratios (HR) with 95% confidence intervals (CI) for the outcome were estimated, using Cox proportional hazard regression analyses. All analyses were stratified by type of intervention and gender.FindingsFour percent died following coronary revascularisation. Cardiovascular disease was the most common cause of death (54%), followed by neoplasms (25%). Regardless of type of intervention, gender and after multivariable adjustments, patients on DP had a higher HR for five-year mortality compared with those not on DP at time of revascularisation (CABG: women HR 2.14; 95% CI 1.59–2.89, men HR 2.09; 1.84–2.38, PCI: women HR 2.25; 1.78–2.83, men HR 1.95; 1.72–2.21). Young women on DP at the time of PCI had a substantially higher HR (HR 4.10; 95% CI: 2.25–7.48).ConclusionPatients on DP at the time of first coronary revascularisation had a higher five-year risk of mortality compared with those not on DP.
Highlights
During the last decades, disability pension (DP), in some countries called early retirement on medical grounds, or incapacity benefit, has become more common in many western countries [1,2,3]
Young women on DP at the time of percutaneous coronary intervention (PCI) had a substantially higher Hazard ratios (HR) (HR 4.10; 95% confidence intervals (CI): 2.25–7.48)
More patients lived in medium sized cities (37%) than in large cities and small communities and had their first coronary revascularisation within year 2002–2006 (46%)
Summary
Disability pension (DP), in some countries called early retirement on medical grounds, or incapacity benefit, has become more common in many western countries [1,2,3]. About 10,000 working-aged women and men with ischemic heart disease undergo coronary revascularisation by coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). These established and well-investigated interventions [7,8,9,10,11,12,13] have resulted in relieved symptoms, improved physical capacity, and over the past decades, a continued decreased mortality, regardless of age and gender [11]. Coronary revascularisation by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are common procedures, little is known regarding disability pension (DP) at the time of coronary revascularisation and its association with mortality. The aim was to investigate the five-year mortality following a first coronary revascularisation among women and men on DP, compared with those not on DP at the time of intervention, accounting for socio-demographic and medical factors
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