Predicting return to work after acute myocardial infarction: Socio-occupational factors overcome clinical conditions.

Mariarita Stendardo,Valeria Casillo,Gianluca Campo,Melissa Bonci,Rossella Miglio,Marco Nardini,Alessandro Fucili,Giulia Giovannini,Piera Boschetto,Chiara Lazzeri

doi:10.1371/journal.pone.0208842

Mariarita Stendardo, Valeria Casillo + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0208842

Copy DOI

Abstract

ObjectivesReturn 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.ParticipantsWe 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.ResultsOf 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.ConclusionsThese 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.

Highlights

Coronary heart disease (CHD) is the leading cause of mortality and morbidity in industrialized countries and acute myocardial infarction (AMI) is one of the five main manifestations of CHD.Almost 45% of patients affected by myocardial infarction are of working age [1], in Italy defined as those aged 18 to 65, and this percentage is expected to increase with the aging of the working population
Educational degree (p = 0.026), self-employment status (p = 0.0005), white collar professional category (p = 0.020) and Hospital Anxiety and Depression (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

Summary

Introduction

Coronary heart disease (CHD) is the leading cause of mortality and morbidity in industrialized countries and acute myocardial infarction (AMI) is one of the five main manifestations of CHD.Almost 45% of patients affected by myocardial infarction are of working age [1], in Italy defined as those aged 18 to 65, and this percentage is expected to increase with the aging of the working population. Infarction mortality is high, the introduction of new treatment regimens for acute management and primary and secondary prevention have improved the prognosis [2] This has led to an increasing number of survivors returning to work after treatment [3]. The impact of these factors on resumption of paid employment is controversial as some studies indicate physical elements, some the psychological and others the socio-demographic or the occupational [1,5,6,7]. Discrepancies in this multitude of factors may be due to non-homogeneous study populations with regard to the performed invasive coronary procedures [percutaneous coronary intervention (PCI) or coronary artery bypass grafting] and whether or not to undergo cardiac rehabilitation. Other possible causes of the inconsistent results in available literature may be: the different study design, in some investigations retrospective, in others prospective and the omitted evaluation of one or more of the main factor groups (i.e. physical, psychological, socio-demographic and occupational) [8,9]

Objectives

Methods

Results

Conclusion