1 Department of Public Health and Primary Care, Ghent University, Gent, Belgium.
2 Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
Eur J Prev Cardiol. 2019 Sep;26(13):1386-1395. doi: 10.1177/2047487319843079. Epub 2019 Apr 10.
Coronary heart disease (CHD) can lead to loss of workability and early retirement. We aimed to investigate return to work (RTW) and its relationship towards psychosocial well-being and health-related quality of life (HRQoL).
Secondary analyses were applied to cross-sectional data from the EUROASPIRE IV survey (European Action on Secondary and Primary prevention through Intervention to Reduce Events).
Participants were examined and interviewed at 6-36 months following the recruiting event. Psychosocial well-being and HRQoL were evaluated by completing the 'Hospital Anxiety and Depression Scale' and 'HeartQoL' questionnaire. Using generalised mixed models, we calculated the odds ratios for RTW. Depression, anxiety and adjusted means of HeartQoL were estimated accounting for RTW.
Out of 3291 employed patients, the majority (76.0%) returned to work, of which 85.6% were men, but there was a general underrepresentation of women. Young ( < 0.001), high-educated ( < 0.001) patients without prior cardiovascular events ( < 0.05) were better off regarding RTW. No significant associations with CHD risk factors and cardiac rehabilitation were established. Those that rejoined the workforce were less susceptible to psychosocial distress (anxiety/depression, < 0.001) and experienced a better quality of life ( < 0.001).
These findings provide evidence that non-modifiable factors (sociodemographic factors, cardiovascular history), more than classical risk factors, are associated with RTW, and that patients who resume work display better psychosocial well-being and HRQoL. Our results illustrate a need for tailored cardiac rehabilitation with a focus on work-related aspects, mental health and HRQoL indicators to reach sustainable RTW, especially in vulnerable groups like less educated and elderly patients.
冠心病（CHD）可导致工作能力丧失和提前退休。我们旨在研究重返工作岗位（RTW）及其与心理健康和健康相关生活质量（HRQoL）的关系。
对 EUROASPIRE IV 调查（通过干预减少事件的二级和一级预防的欧洲行动）的横断面数据进行了二次分析。
在招募事件后 6-36 个月对参与者进行检查和访谈。通过完成“医院焦虑和抑郁量表”和“心脏生活质量问卷”评估心理社会健康和 HRQoL。使用广义混合模型，我们计算了 RTW 的优势比。考虑到 RTW，估计了抑郁、焦虑和调整后的 HeartQoL 平均值。
在 3291 名在职患者中，大多数（76.0%）重返工作岗位，其中 85.6%为男性，但女性普遍代表性不足。年轻（ < 0.001）、高学历（ < 0.001）、无心血管病史（ < 0.05）的患者 RTW 更好。与 CHD 危险因素和心脏康复无显著相关性。重返工作岗位的人受心理社会困扰（焦虑/抑郁， < 0.001）和生活质量（ < 0.001）的影响较小。
这些发现提供了证据表明，不可改变的因素（社会人口因素、心血管病史）比传统的危险因素更与 RTW 相关，并且恢复工作的患者表现出更好的心理社会健康和 HRQoL。我们的研究结果表明，需要量身定制的心脏康复，重点关注与工作相关的方面、心理健康和 HRQoL 指标，以实现可持续的 RTW，特别是在脆弱群体如教育程度较低和老年患者中。
