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[ReTurn To work of coronary patient: RTT French multicentre study]
Bruno Pavy1, Marie-Christine Iliou2, Sophie Péclet3
1centre hospitalier Loire-Vendée-Océan, Machecoul, France.
Insights
Return to work after acute coronary syndrome (ACS) is achievable for most patients, but delays persist. Improving access to cardiac rehabilitation and exploring tele-rehabilitation can help patients return to work faster.
Area of Science:
- Cardiology
- Occupational Health
- Public Health
Background:
- Coronary heart disease (CHD) significantly impacts morbidity, mortality, and societal costs.
- Resuming work is crucial for patients with CHD.
- Limited and outdated French data necessitate updated research on return-to-work rates.
Purpose of the Study:
- To update data on work resumption after acute coronary syndrome (ACS) in France.
- To identify factors influencing return-to-work rates and timing.
- To inform strategies for improving work reintegration for cardiac patients.
Main Methods:
- A multicentre study involving patients who experienced ACS and were working.
- Data collected via questionnaires on pathology, occupation, and work plans.
- Clinical and professional situations analyzed at a 6-month follow-up interview.
Main Results:
- An 81% return-to-work rate was observed, with 93% returning to their previous positions.
- Key factors for non-return included reduced left ventricular ejection fraction, angina, heart failure, and demanding occupational conditions (shift work, cold exposure, imposed work rates).
- Delayed rehabilitation access, heavy loads, poor postures, and lack of patient/physician project planning extended return-to-work times.
Conclusions:
- Return-to-work rates post-ACS remain stable, but the time to return is considerable.
- Enhanced access to cardiac rehabilitation, including tele-rehabilitation, is recommended.
- Optimizing rehabilitation can improve patient outcomes and economic benefits.
Introduction:
Coronary heart disease remains one of the leading causes of morbidity and mortality, and is responsible for significant social costs. Resumption of work is an essential objective when this pathology concerns working patients. French data remain patchy and relatively old. The French Society of Cardiology's Exercise, Rehabilitation, Sport and Prevention Group has proposed a multicentre study to update these data.
Methods:
Following an acute coronary syndrome (ACS), the cardiology team asked the patient, who was currently working, to complete a questionnaire on his or her pathology, occupation and plans to return to work. An interview after 6 months enabled the clinical and professional situation of the patient to be analyzed, in order to study the factors predictive of a return to work.
Results:
364 patients were included in 6 interventional and 17 cardiac rehabilitation centres between 2018 and 2019. The resumption rate was 81% (n = 295), 93% of them in the same position, with a mean delay of 106 ± 56 days. The cardiologic independent factors for non-return were left ventricular ejection fraction, the presence of an anticoagulant, angina or heart failure, and occupational factors, shift work, exposure to cold, and imposed work rates. Factors that lengthened the time taken to return to work included delayed access to rehabilitation, the carrying of heavy loads, difficult postures and imposed work rates, as well as the patient's lack of a project, the absence of a cardiologist's opinion and the request for a modified workstation.
Conclusion:
The rate of return to work remains fairly stable despite the evolution of disease management, and the time to return to work relatively high. One way of improving the situation is to enhance access to cardiac rehabilitation programs, for example by offering alternatives such as tele-rehabilitation for a proportion of patients. This will free up more time for more severe patients, to better prepare them physically and psychologically for a return to work, which will also have a beneficial economic effect.
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