Interdisciplinary support program (INA) for patients discharged from cardiac rehabilitation - a program to improve return to work rates after myocardial infarction and/or coronary artery bypass surgery

Occupational reintegration after coronary heart disease of patients who are insured by the German workers pension (Arbeiterrentenversicherung) succeed s in 40-60% of the recorded cases. Patients who were not able to return to work after finishing their regular cardiac rehabilitation took part in a program called "Intensivierte Nachsor ge (INA)". INA is an interdisciplinary support program, taking place twice a week for a whole day over a period of six weeks. On the remaining three d ays patients were either progressively reintegrated into their working plac e or stayed at home. The results of the INA group were compared to those of a control group. Two years after patients had terminated the cardiac rehabilitation, statist ically significant effects could still be found: 70.2% of the INA group had returned to work compared to 52.6% of the control group. This is a differe nce of 17.6%. After the results had been corrected by considering age diffe rences between the two groups, the control group had a recalculated return to work rate of 57.4%. A significant difference of 12.8% could still be ide ntified with respect to the INA group. Support programs which follow regular cardiac rehabilitation seem to be spe cially suitable for older patients with highly perceived job strain, becaus e our results showed that these patients had lower return to work rates. 44 .2% of the INA group and 21.9% of the control group were progressively rein tegrated into their work place. Two years after their regular rehabilitatio n 36.3% of the INA group patients took part in ambulatory heart groups comp ared with 10.4% of the control group. It was also found that patients of the INA group showed improvements in act ivities of daily life. The INA program however does not seem to have an inf luence on behavioral components such as eating habits, relaxation, and smok ing as well as on the psychological status. The physical fitness measured in watt x min at the beginning of the INA pro gram (T1) was 589.46+/-255.03 in the control group. This number increased t o 598.32+/-276.01 six months after regular rehabilitation (T3) and continue d to rise to 661.151+/-362.01 after two years (T4). In the INA group the nu mbers were as follows: 658.13+/-263.63 at T1, 751.83+/- 318.15 at T3, and 7 17.93+/-336.76 at T3. The differences between the groups are significant at T1 and T3, whereas at T4 there is no significant difference. It should als o be stated that the lipid parameters indicated no differences between the groups except for the triglyceride values which were significantly lower st atistically in the INA group than in the control group.