[Intensified after-care--a method for improving occupational reintegration after myocardial infarct and/or bypass operation]

Abstract

Occupational reintegration after coronary heart disease of patients who are insured by the German workers pension (Arbeiterrentenversicherung) succeeds 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 Nachsorge (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 days patients were either progressively reintegrated into their working place 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, statistically 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 difference of 17.6%. After the results had been corrected by considering age differences 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 identified with respect to the INA group. Support programs which follow regular cardiac rehabilitation seem to be specially suitable for older patients with highly perceived job strain, because 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 reintegrated into their work place. Two years after their regular rehabilitation 36.3% of the INA group patients took part in ambulatory heart groups compared with 10.4% of the control group. It was also found that patients of the INA group showed improvements in activities of daily life. The INA program however does not seem to have an influence on behavioral components such as eating habits, relaxation, and smoking as well as on the psychological status. The physical fitness measured in watt x min at the beginning of the INA program (T1) was 589.46 +/- 255.03 in the control group. This number increased to 598.32 +/- 276.01 six months after regular rehabilitation (T3) and continued to rise to 661.15 +/- 362.01 after two years (T4). In the INA group the numbers were as follows: 658.13 +/- 263.63 at T1, 751.83 +/- 318.15 at T3, and 717.93 +/- 336.76 at T4. The differences between the groups are significant at T1 and T3, whereas at T4 there is no significant difference. It should also be stated that the lipid parameters indicated no differences between the groups except for the triglyceride values which were significantly lower statistically in the INA group than in the control group.