AHA 2017: Patients who stop working after acute myocardial infarction can suffer lower quality of life

November 12, 2017 – Adverse changes in employment after a heart attack are associated with increased depression, financial hardship, lower quality of life.

A new study, the largest of its kind to date, looked at the effects of a severe heart attack, or acute myocardial infarction (AMI), on work status and how that affected patients’ recovery. The DCRI’s Haider Warraich, MD, presented the findings at the American Heart Association’s annual meeting this month in Anaheim, California.

Cardiovascular disease is the leading cause of morbidity and mortality in the United States, and AMI accounts for a significant proportion of the disease burden of cardiovascular disease. Advances in prevention and treatment strategies have led to significant improvement in clinical outcomes, but it remains unclear, Warraich said, if similar progress has been made in outcomes that are particularly patient-centric, such as the ability to maintain or return to work. Employment, or the lack thereof, is a significant social determinant of health.

“With new treatments and better rehab, we’re getting very good at helping people survive heart attacks,” said Warraich. “But are we also getting better at understanding other important aspects of patient recovery? We’re especially interested in whether they can return to work after a heart attack, and whether they can get back to working at the same level.”

Warraich and his team used data from the “Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome” (TRANSLATE-ACS) registry (2010-2012) to assess the prevalence of adverse change in employment within one year after AMI in a contemporary U.S. cohort.

The final study population had nearly 9,400 AMI patients enrolled at 233 U.S. hospitals with a mean age of nearly 56. Half of the patients were working at baseline, the other half not. Of those not working, 73 percent were retired.

Historically, Warraich said, a heart attack prevented most patients from ever returning to work; there was a high rate of mortality and survivors’ health was so damaged that they could no longer perform meaningful work, especially manual labor. Earlier studies also noted that some patients would take a year off after a heart attack and only then return to work.

Warraich’s data sheds contemporary insights into patients’ ability to return to work after AMI. The study showed that among patients working at baseline, 10 percent reported an adverse change in work status 12 months later, with 7 percent no longer working and 3 percent working less. However, 88 percent of those reporting an adverse work status change by six weeks no longer had an adverse work change by one year, among other findings.

“We found increased depression and lower quality of life in patients who experience adverse change in their employment,” said Warraich. “So in addition to the focus on clinical outcomes, we need to address those who lose their jobs. How do we identify which patients would be at increased risk of adverse change?”

Factors associated with adverse change in employment included the number of unplanned readmissions patients experienced, bleeding complications post-stenting, hypertension, and smoking.

“Not surprisingly, we also found that patients who had an adverse change in their work experienced increased hardship with medical costs,” Warraich said. “All of these findings have important implications for patient-centered care for contemporary AMI patients.”

In addition to Warraich, Duke and DCRI contributors to the study included Lisa Kaltenbach, Eric Peterson, and Tracy Wang.