Salzwedel, Annett; Reibis, Rona; Wegscheider, Karl; Eichler, Sarah; Buhlert,
Hermann; Kaminski, Stefan; Völler, Heinz.
Clinical Research in Cardiology, March 2016, Vol. 105 Issue: Number 3 p257-267, 11p;
Abstract: Return to work (RTW) is a pivotal goal of cardiac
rehabilitation (CR) in patients after acute cardiac event. We aimed to
evaluate cardiopulmonary exercise testing (CPX) parameters as
predictors for RTW at discharge after CR. We analyzed
data from a registry of 489 working-age patients (51.5 ± 6.9 years,
87.9 % men) who had undergone inpatient CR predominantly after
percutaneous coronary intervention (PCI 62.6 %), coronary artery bypass
graft (CABG 17.2 %), or heart valve replacement (9.0 %).
Sociodemographic and clinical parameters, noninvasive cardiac
diagnostic (2D echo, exercise ECG, 6MWT) and psychodiagnostic screening
data, as well as CPX findings, were merged with RTW data from the
German statutory pension insurance program and analyzed for prognostic
ability. During a mean follow-up of
26.5 ± 11.9 months, 373 (76.3 %) patients returned to work, 116
(23.7 %) did not, and 60 (12.3 %) retired. After adjustment for
covariates, elective CABG (HR 0.68, 95 % CI 0.47–0.98; p= 0.036) and
work intensity (per level HR 0.83, 95 % CI 0.73-0.93; p= 0.002) were
negatively associated with the probability of RTW. Exercise capacity in
CPX (in Watts) and the VE/VCO2-slope had independent prognostic
significance for RTW. A higher work load increased (HR 1.17, 95 % CI
1.02–1.35; p= 0.028) the probability of RTW, while a higher
VE/VCO2slope decreased (HR 0.85, 95 % CI 0.76–0.96; p= 0.009) it. CPX
also had prognostic value for retirement: the likelihood of retirement
decreased with increasing exercise capacity (HR 0.50, 95 % CI
0.30–0.82; p= 0.006).
CPX is a valid tool for
assessing patients’ ability to return to work. Therefore, it may be an
essential part of functional assessment during CR for predicting
participation in employment.