Original Article
A prospective study found impaired left ventricular function predicted job retirement after acute myocardial infarction

https://doi.org/10.1016/j.jclinepi.2003.12.022Get rights and content

Abstract

Objective

Impaired left ventricular function is associated with poor prognosis after acute myocardial infarction (MI). It might be hypothesized that impaired left ventricular function would also affect work outcome; however, no existing data address this hypothesis. This study examines whether reduced left ventricular systolic function had any influence on the 4-year retirement rate after acute MI.

Study design and setting

We conducted a prospective study including 242 working-active patients with MI. Left ventricular ejection fraction (LVEF) was estimated by echocardiography during hospital admission. Data about work outcome after 4 years were collected by telephone interviews.

Results

Fifty percent were retired by the end of follow-up. Moderately or severely reduced LVEF (⩽35%) increased the risk of retirement almost twofold (risk ratio RR = 1.8, 95% confidence interval CI = 1.3–2.5). After adjusting for confounding factors, reduced LVEF was an independent predictor of retirement. Based on a stratified analysis, being female (RR = 3.90, 95% CI = 1.18–12.62) or having heavy physical job demands (RR = 3.83, 95% CI = 1.02–14.30) had a more pronounced impact on retirement for patients with LVEF ⩽ 35%, compared with patients with better left ventricular function.

Conclusion

We conclude that impaired left ventricular systolic function is a prognostic determinant of retirement from the job market after acute MI.

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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  • Cited by (0)

    This study was supported by grants from The Danish Heart Foundation and The Health Insurance Foundation, Copenhagen, Denmark.

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