Influence of patients’ expectation of return to work on employable discharge from multi-component cardiac rehabilitation after acute cardiac event

Abstract

Psychosocial factors such as depression and negative expectations reduce the probability of return to work after cardiac rehabilitation (CR). We aimed to characterize patients after an acute coronary syndrome (ACS) or cardiac surgery with negative expectations in terms of return to work and its impact on employable discharge from CR. We analyzed data from 884 CR-patients (52 ± 7 years, 76% men). The 3-week inpatient multi-modal CR started within 14 days after discharge from hospital. Sociodemographic data (age, sex, education level), diagnoses, functional data (exercise stress test, 6-min walking test [6MWT]), hospital anxiety and depression scale (HADS) as well as self-assessment of occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were taken from patient records. The status at discharge from CR (employable vs. not) as primary outcome was analyzed by regression model. In total, 384 patients (43%) had an unfavourable occupational prognosis: 368 of these (96%) expected no return to work after CR; 113 (29%) were unemployed before CR. Affected patients showed reduced exercise capacity (ergometry: 100 vs. 118 W, P < 0.01; 6MWT 380 vs. 421 m, P < 0.001), more often depression diagnosis (12% vs. 3%, P < 0.001) and higher HADS-levels (anxiety 7.7 vs. 5.9 points, P < 0.01; depression 6.9 vs. 4.9, P < 0.001). At discharge, 21% of this group ( n = 81) were employable [vs. 35% of patients with normal occupational prognosis ( n = 175), P < 0.01]. The probability of employable discharge was reduced by sick leave before ACS and negative occupational expectations. An additional unemployment and higher exercise capacity were positively associated ( Fig. 1 ). A high proportion of patients in CR after ACS expected no return to work. These patients showed often a reduced physical performance and high psychosocial burden. Patients’ occupational expectation is a predictor of employable discharge from CR. Therefore, affected patients should be identified at admission to allow a targeted psychological care.