Return to Work Characteristics Following Adverse Cardiovascular Events in Adults with Congenital Heart Disease

Introduction:
Adults with congenital heart disease (CHD) are at increased risk for major adverse cardiovascular events (MACE), including stroke, myocardial infarctions, and heart failure. Following survival of MACE, an important metric of resultant morbidity is re-entry to the workforce. This study sought to characterize the differences in return-to-work (RTW) characteristics between the MACE survivors with CHD and those in the general population without CHD.

Methods:
By linking Danish health and administrative registries, a cohort of adults with CHD who survived a MACE were matched 1:10 by age at MACE, year of MACE, and sex to MACE survivors without CHD. The Danish Rational Economic Agent Model (DREAM) database was used to ascertain working status and municipal health-related disability payments made to patients before and during the year following MACE. Only patients employed prior to MACE and whose MACE hospitalizations exceeded 24 hours were examined. Logistic regression assessed working status relative risk at 3, 6, and 12 months after the MACE event. For patients who were admitted more than 1 day and received municipal disability payments, Cox regression hazard ratio was used to characterize time to maintained RTW, defined as a period of employment of 3 months or greater. Adjustments were made for comorbidities, educational achievement, income quartile, and co-occupancy status.

Results:
During 1992-2017, 538 CHD patients survived MACE at a median age of 47 years. These patients were matched to 4,930 MACE survivors without CHD. At 1 year after MACE, 73.1% of the CHD cohort were working, compared to 78.4% of those without CHD. Within this year, the adjusted odds ratios of having returned to work were 0.91 (95% confidence interval (CI): 0.73-1.14) of employment at 3 months, 0.77 (95% CI: 0.61-0.96) at 6 months, and 0.76 (95% CI: 0.61-0.96) at 12 months (Figure 1). Of those who required municipal disability payments after MACE, the 202 CHD patients adjusted hazard ratio of maintained RTW was 0.83 (95% CI: 0.69-0.99) compared to the general population without CHD.


Conclusions:
Patients with CHD who survive a MACE have evidence of impaired RTW ability exceeding that of those without CHD. Further research is needed to understand and augment functional recovery in this complex population.