225Impact of self-assessment of return to work on employable discharge from multi-component cardiac rehabilitation

Abstract

Introduction: Psychosocial factors such as depression, fear avoidance beliefs and negative expectations reduce the probability of return to work after cardiac rehabilitation (CR).We aimed to characterize patients after an acute cardiac event with negative expectations in terms of return to work and its impact on employable discharge from CR. Method(s): We analyzed data from 884 consecutive patients (52+/-7 years, 76% men) who were referred for CR after an acute coronary syndrome (ACS) or cardiac surgery between 10/2013 and 03/2015. The 3-week inpatient multi-modal CR started within 14 days after discharge from hospital. Sociodemographic data (e.g. age, sex, education level), diagnoses, functional data (e.g. exercise stress test, 6-min walking test [6MWT]), hospital anxiety and depression scale (HADS) as well as self-assessment of occupational prognosis (negative expectations and/or unemployment, Wurzburger screening) at admission to CR were taken from patient records. The status of capacity to work (fit vs unfit) at discharge from CR as primary outcome was analyzed by regression model. Result(s): An unfavourable occupational prognosis was detected in 384 patients (43%): 368 patients (96%) expected no return to work after CR; 113 (29%) were unemployed before CR. Patients with negative prognosis suffered from reduced exercise capacity (bicycle stress test: 100 vs 118 W, p<0.01; 6MWT 380 vs 421 m, p<0.001) and were more likely to experience depression (12% vs 3%, p<0.001) as well as higher levels in HADS (anxiety: 7.7 vs 5.9 points, p<0.01; depression: 6.9 vs. 4.9, p<0.00). At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with normal occupational prognosis (n=175), p<0.01). The probability for employable discharge was reduced by sick leave before cardiac event (OR 0.4, 95% CI 0.2-0.6, p<0.01) and negative occupational expectations (OR 0.4, 95% CI 0.3-0.7, p<0.01). An additional unemployment and higher exercise capacity were positively associated (figure). Conclusion(s): A high proportion of patients in CR after a cardiac event expected no return to work. These patients reveiled often a reduced physical performance and suffered from a high psychosocial burden. In addition, patients' occupational expectation is a predictor of employable discharge from CR. Therefore, affected patients should be identified at admission to allow a targeted psychological care.