Return to work: does cardiac rehabilitation make a difference? Danish nationwide register-based study

Area of Science:

• Cardiology
• Public Health
• Rehabilitation Medicine

Background:

• Ischaemic heart disease (IHD) significantly impacts patients' ability to return to work.
• Cardiac rehabilitation (CR) is a crucial component of post-IHD care, aiming to improve patient outcomes.
• Socioeconomic factors and comorbidities can influence access to and participation in CR.

Purpose of the Study:

• To evaluate the effect of participation in cardiac rehabilitation on the probability of returning to work after ischaemic heart disease.
• To investigate potential disparities in CR access and their impact on return-to-work rates.

Main Methods:

• A cohort of 24,509 patients (18-70 years) discharged after inpatient admission for IHD (ICD-10 I20-I25) and previously employed were analyzed.
• Exposure was defined as participation in CR (N=15,742). Primary outcomes were binary indicators of employment status.
• Coarsened exact matching (CEM) was employed to reduce selection bias, followed by logistic regression analysis on the matched population (N=15,762).

Main Results:

• Patients receiving CR were less likely to return to work at 3 months (OR 0.81, 95%CI: 0.77-0.84).
• However, CR participation was associated with a higher, though initially insignificant, probability of return to work at 6 months (OR 1.02, 95%CI: 0.97-1.08).
• A significantly higher probability of returning to work was observed at 9 months (OR 1.08, 95%CI: 1.02-1.15) and 12 months (OR 1.20, 95%CI: 1.13-1.28) for CR participants.

Conclusions:

• Deprived and comorbid patients exhibit lower utilization of cardiac rehabilitation.
• After reducing selection bias through matching, cardiac rehabilitation was found to increase the probability of returning to work.
• These findings underscore the importance of equitable access to CR for improving long-term employment outcomes in IHD patients.