Work-related outcome after acute coronary syndrome: Implications of complex cardiac rehabilitation in occupational medicine
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Second University of Naples, Naples, Italy (Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, School of Medicine)
S. Giovanni Bosco Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Intensive Care Unit)
S. Gennaro Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Cardiac Rehabilitation)
University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Institute for Health Services Research in Dermatology and Nursing)
Institution for Statutory Accident Insurance and Welfare Services, Hamburg, Germany (Department of Occupational Health Research)
Corresponding author
Monica Lamberti   

Second University of Naples, Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, School of Medicine, De Crecchio 13, 80100 Naples, Italy
Int J Occup Med Environ Health. 2016;29(4):649-57
Objectives: Coronary heart disease is frequent in the working-age population. Traditional outcomes, such as mortality and hospital readmission, are useful for evaluating prognosis. Fit-for-work is an emerging outcome with clinical as well as socioeconomic significance. We describe the possible benefit of a cardiac rehabilitation (CR) program for return to work (RTW) after acute coronary syndrome (ACS). Material and Methods: We evaluated 204 patients with recent ACS. They were divided into 4 groups on the basis of their occupational work load: very light (VL), light (L), moderate (M), and heavy (H). Work-related outcomes were assessed with the Work Performance Scale (WPS) of the Functional Status Questionnaire and as “days missed from work” (DMW) in the previous 4 weeks. The variables considered for outcomes were percent ejection fraction, functional capacity expressed in metabolic equivalents (METs), and participation or non-participation in the CR program (CR+ and CR–). Results: One hundred thirty (66%) patients took part in the CR program. Total WPS scores for CR+ and CR– subgroups were VL group: 18±4 vs. 14±4 (p < 0.001), L group: 18±3 vs. 14±3 (p < 0.0001), M group: 19±3 vs. 16±3 (p < 0.003), and H group: 20±4 vs. 17±3 (p < 0.006). Fewer DMW were reported by the CR+ group. Conclusions: Non-participation in CR was a consistent cause of poorer work-related outcomes. Our findings indicate that CR and occupational counseling play a very important role in worker recovery and subsequent reintegration in the workplace, in particular among clerical workers.
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