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Job loss after MI may confer depression, financial hardship
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Among patients with MI, those working less or unable to work reported lower quality of life with increased depression and difficulty affording their medication, according to a study published in Circulation: Cardiovascular Quality and Outcomes.
According to Haider J. Warraich, MD, cardiologist at Duke University Medical Center and the Duke Clinical Research Institute, and colleagues, the results of the study underscore that interventions are needed to address this patient-centered outcome and its health impact.
“Social determinants of health are strongly linked to the risk of heart disease, with employment — or the lack of employment — being one of the most significant,” Warraich said in a press release. “Job loss significantly interacts with other psychosocial factors such as depression and health status.”
Due to the implications that the inability to resume employment after acute MI may have on patients, the researchers examined data from 9,319 patients with MI enrolled in a longitudinal registry at 233 U.S. hospitals to assess the prevalence of and outcomes associated with adverse change in employment after MI.
Using the TRANSLATE-ACS study, Warraich and colleagues assessed employment status at baseline and 1 year among patients with MI (mean age, 61 years; 27.3% women).
Adverse change in employment was defined as patients working at baseline but working less or not working at 1 year after MI.
Changes in employment
Fifty-one percent of patients were employed at the time of MI. At 1 year, 10% reported changes in employment, with 3% working less and 7% no longer working.
It was found that factors significantly associated with adverse change in employment included a number of unplanned readmissions, postdischarge bleeding complications, hypertension and smoking.
Patients with an adverse change in employment were more likely to report depression (Patient Health Questionnaire-2 score > 3: 27.4% vs. 16.7%), lower health status based on mean EuroQoL visual analogue scale score (change group, 73; standard deviation, 17.8; no-change group, 78; standard deviation, 14.8) and moderate to extreme financial hardship with medication costs (41% vs. 28.4%; P < .001 for all) at 1 year, according to the researchers.
They observed no difference in adherence to evidence-based medications prescribed at discharge.
“These findings help us identify patients at high risk of not returning to work,” Warraich said in the release. “This can help us focus our resources on, for example, patients readmitted after a heart attack, as a way of targeting those at most risk of not returning to work.”
Support needed
The findings lacked detailed information on work type such as professional, clerical, skilled and occupational characteristics like level of stress, social support and job satisfaction, Rachel P. Dreyer, PhD, of the department of emergency medicine at Yale University School of Medicine, and Victoria Vaughan Dickson, PhD, RN, of New York University Rory Meyers College of Nursing, wrote in an accompanying editorial.
“As the demographics of America’s workforce changes, the magnitude of [acute MI] among working adults and the need for interventions that support successful return to work requires continued attention by researchers and clinicians,” they wrote. – by Dave Quaile
Disclosures: Dickson, Dreyer and Warraich report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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