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. 2021 Jan 22:76:e2553.
doi: 10.6061/clinics/2021/e2553. eCollection 2021.

Factors associated with actively working in the very long-term following acute coronary syndrome

Jose C Nicolau  1 , Remo H M Furtado  1   2 , Talia F Dalçóquio  1 , Livia M Lara  1 , Marcela G Juliasz  1 , Aline G Ferrari  1 , Carlos A K Nakashima  1 , Andre Franci  1 , Cesar A C Pereira  1 , Felipe G Lima  1 , Roberto R Giraldez  1 , Rocío Salsoso  1 , Luciano M Baracioli  1 , Shaun Goodman  3
Affiliations

Factors associated with actively working in the very long-term following acute coronary syndrome

Jose C Nicolau et al. Clinics (Sao Paulo). .

Abstract

Objectives: Returning to work after an episode of acute coronary syndrome (ACS) is challenging for many patients, and has both personal and social impacts. There are limited data regarding the working status in the very long-term after ACS.

Methods: We retrospectively analyzed 1,632 patients who were working prior to hospitalization for ACS in a quaternary hospital and were followed-up for up to 17 years. Adjusted models were developed to analyze the variables independently associated with actively working at the last contact, and a prognostic predictive index for not working at follow-up was developed.

Results: The following variables were significantly and independently associated with actively working at the last contact: age>median (hazard-ratio [HR], 0.76, p<0.001); male sex (HR, 1.52, p<0.001); government health insurance (HR, 1.36, p<0.001); history of angina (HR, 0.69, p<0.001) or myocardial infarction (MI) (HR, 0.76, p=0.005); smoking (HR, 0.81, p=0.015); ST-elevation MI (HR, 0.81, p=0.021); anterior-wall MI (HR, 0.75, p=0.001); non-primary percutaneous coronary intervention (PCI) (HR, 0.77, p=0.002); fibrinolysis (HR, 0.61, p<0.001); cardiogenic shock (HR, 0.60, p=0.023); statin (HR, 3.01, p<0.001), beta-blocker (HR, 1.26, p=0.020), angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB) (HR, 1.37, p=0.001) at hospital discharge; and MI at follow-up (HR, 0.72, p=0.001). The probability of not working at the last contact ranged from 24.2% for patients with no variables, up to 80% for patients with six or more variables.

Conclusions: In patients discharged after ACS, prior and in-hospital clinical variables, as well as the quality of care at discharge, have a great impact on the long-term probability of actively working.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Supplemental Figure 1
Supplemental Figure 1. Flowchart of the study patients.
Figure 1
Figure 1. Kaplan-Meyer estimates for working over the course of time from the index event.
Figure 2
Figure 2. Prognostic index for not actively working at the last contact. The prognostic index included the following variables: history of angina, myocardial infarction, anterior-wall location on ECG, non-primary percutaneous coronary intervention, fibrinolysis, cardiogenic shock, myocardial infarction after hospital discharge, and age above the median (log-rank p<0.001).
See this image and copyright information in PMC

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