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Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation

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Abstract

Background

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.

Methods

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.

Results

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/VCO2 slope 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).

Conclusion

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.

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Acknowledgments

This study was funded by a grant from the German statutory pension insurance program, Berlin-Brandenburg.

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Authors and Affiliations

  1. Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany

    Annett Salzwedel, Sarah Eichler & Heinz Völler

  2. Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam, Germany

    Rona Reibis

  3. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Karl Wegscheider

  4. Department of Cardiology, Klinik am See, Rüdersdorf, Germany

    Hermann Buhlert, Stefan Kaminski & Heinz Völler

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  1. Annett Salzwedel
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Correspondence to Heinz Völler.

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Salzwedel, A., Reibis, R., Wegscheider, K. et al. Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation. Clin Res Cardiol 105, 257–267 (2016). https://doi.org/10.1007/s00392-015-0917-1

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