Return to work after cardiovascular events

Introduction
Work, if matched to one’s knowledge and skills and undertaken in a healthy and safe environment, can help people in recovering from illness. Promoting return to work (RTW) in the follow-up care of workers after cardiovascular events like acute coronary syndrome (ACS) will promote health because returning to work encourages the patient to be active in daily life. Participation in work in case of ACS is, however, influenced by many factors that may facilitate or hinder workers in active return. Important prognostic factors can be identified and used in intervention programs on RTW.

Methods
Literature review on prognostic factors and effectiveness of interventions for return to work after an ACS, and a retrospective semi-structured telephone survey two to three years after hospitalisation with 84 employed Dutch ACS-patients from an academic medical hospital.

Results
Although in the Dutch survey, 58% of the patients had resumed work within 3 months, after 24 months 36% had not resumed work or was not working full time or was sicklisted again. From this study and from the literature the most predictive factor for RTW after ACS can be identified: clinical factors (arrhythmia, physical capacity, and co-morbidity, in particular depression), personal factors (age, gender, SES, and illness perception), occupational factors (favourable working conditions), and social insurance regulations. Good quality evidence exists that shorter period between diagnosis or discharge and consultation of a professional in RTW increases the chance of successful RTW in ACS patients. Especially, RTW interventions within a cardiac rehabilitation programme are effective. Evidence-based guidelines have recently been developed

Discussion
In spite of progress in the medical treatment, RTW after ACS is often still a problem. Important prognostic factors can be identified and used in an intervention program. RTW should be obligatory part of cardiac rehabilitation. Evidence-based guidelines are available but should be evaluated on their effectiveness.