H. Boudrez et G. De Backer, Recent findings on return to work after an acute myocardial infarction or coronary artery bypass grafting, ACT CARDIOL, 55(6), 2000, pp. 341-349
Objective - To examine during recent years the rate of work resumption afte
r an acute myocardial infarction or coronary artery bypass surgery, and to
analyse variables that predicted return to work.
Setting - Referral centre for cardiac rehabilitation at the university hosp
ital in Gent.
Patients - 227 consecutive patients (90 after a first AMI; 137 after a firs
t CABG) were selected for participation. All patients were less than 60 yea
rs old and in a social state that still allowed return to work. During hosp
italisation, a set of questionnaires, validated as well as self-developed,
was presented, measuring psychological and social variables. Medical variab
les were collected from the medical records. One year later, a follow-up qu
estionnaire was sent by mail, measuring return to work, reasons for not ret
urning, morbidity, and psychological well-being.
Results - Return to work was observed in 185/222 (83.3%) of the total study
group; 75/86 (87.2%) of the AMI patients and 110/136 (80.8%) of the CABG p
atients. The mean delay for return to work was 14.8 weeks. After one year,
patients who returned to work, showed more positive affect, less negative a
ffect, less somatic complaints and less cognitive complaints. This better p
sychological profile was not affected by the morbidity score. Variables pre
dicting return to work in CABG patients were different from those in AMI pa
tients. Only two medical variables could be retained in CABG patients (good
left venticular function and a larger degree of revascularisation). Mainly
psychological variables had predictive power (trust, job security, positiv
e expectations concerning return, no attribution to stress, less somatic co
mplaints, less physical exertion of the job).
Conclusions - Return to work remains one of the main issues in cardiac reha
bilitation after AMI or CABG. If resumption is sufficiently emphasized, a h
igh success rate can be achieved. This approach should include a psychosoci
al strategy starting already during hospitalisation.