Original ArticleA prospective study found impaired left ventricular function predicted job retirement after acute myocardial infarction☆
Introduction
Several medical and nonmedical factors have been associated with premature retirement from the job market by patients surviving acute myocardial infarction (MI) [1]. Interventional rehabilitation studies, however, have not shown any convincing effect on work outcome [2], [3], [4], [5], [6], [7], [8], [9], [10]. Rehabilitation programs may not have targeted high-risk groups because of lack of valid data on prognostic factors for retirement. More data are therefore needed on prognostic factors for retirement after MI [1].
Left ventricular function is a strong predictor of adverse events after MI [11]. Work outcome likely depends on left ventricular function, but there are no published data to support this hypothesis [12], [13], [14], [15]. We therefore examined the influence of reduced left ventricular systolic function on the 4-year retirement rate in order to determine whether other factors modify the association.
Section snippets
Materials and methods
All surviving MI patients who had been in full- or part-time employment and who were admitted consecutively to the Department of Cardiology, Herlev University Hospital (Denmark), from October 10, 1990, to March 31, 1993, or to the Department of Cardiology, Gentofte University Hospital (Denmark), from September 1, 1991, to March 31, 1993, were asked to participate in the study.
Preadmission data on various sociodemographic, job-related, psychological, and medical conditions were obtained through
Baseline characteristics
Differences in the prevalence of selected variables of interest, according to the level of left ventricular systolic function, are given in Table 1. Significant differences in considerations regarding retirement, negative expectations about returning to work, and diabetes mellitus were observed.
The crude associations between the selected baseline variables and retirement are also shown in Table 1.
Total mortality, reinfarction, and invasive procedures
A total of 27 (11%) of the subjects discharged alive had died during the 4-year follow-up period.
Left ventricular function and work outcome
Beyond the well-known association between left ventricular function and mortality [11], we also found that left ventricular function was a predictor of work outcome. By contrast with previous reports [12], [13], [14], [15], we showed that the sick-leave period and rate of return to work during the first 6 months after MI was influenced by left ventricular systolic function. Further, we showed that patients who returned to work more often stopped working again if they had reduced left
Conclusion
The present study is the first we know of to investigate the association between reduced left ventricular systolic function and the long-term work outcome after MI. We show that impaired left ventricular systolic function is an independent prognostic determinant of retirement from the job market after MI, and that women and patients with heavy physical job demands seem particularly vulnerable when left ventricular systolic function is moderately or severely reduced.
Acknowledgements
The authors gratefully acknowledge the help of Anni Therkelsen, RN, in conducting the study interviews and echocardiographic examinations.
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This study was supported by grants from The Danish Heart Foundation and The Health Insurance Foundation, Copenhagen, Denmark.