Key result
Statin prescription at hospital discharge was independently associated with a significantly higher probability of actively working in the long-term after acute coronary syndrome (HR 3.01).
Why the study?
Returning to work after acute coronary syndrome is challenging and impactful, but data regarding working status in the very long term are limited.
What clinical and demographic factors are associated with actively working in the very long-term following acute coronary syndrome?
Cohort (n=1,632)
No
What clinical and demographic factors are associated with actively working in the very long-term following acute coronary syndrome?
Hazard Ratio: 3.01 (95% CI 2.43–3.71)
p-value: p=<0.001
Prior and in-hospital clinical variables, as well as quality of care at discharge (e.g., statin, beta-blocker, ACEi/ARB use), significantly impact the long-term probability of returning to work after ACS.
May aid return-to-work prognostication after ACS using discharge factors; leaves open causality in this observational cohort.
OBJECTIVES: Returning to work after an episode of acute coronary syndrome (ACS) is challenging for many patients, and has both personal and social impacts. There are limited data regarding the working status in the very long-term after ACS. METHODS: We retrospectively analyzed 1,632 patients who were working prior to hospitalization for ACS in a quaternary hospital and were followed-up for up to 17 years. Adjusted models were developed to analyze the variables independently associated with actively working at the last contact, and a prognostic predictive index for not working at follow-up was developed. RESULTS: The following variables were significantly and independently associated with actively working at the last contact: age>median (hazard-ratio [HR], 0.76, p<0.001); male sex (HR, 1.52, p<0.001); government health insurance (HR, 1.36, p<0.001); history of angina (HR, 0.69, p<0.001) or myocardial infarction (MI) (HR, 0.76, p=0.005); smoking (HR, 0.81, p=0.015); ST-elevation MI (HR, 0.81, p=0.021); anterior-wall MI (HR, 0.75, p=0.001); non-primary percutaneous coronary intervention (PCI) (HR, 0.77, p=0.002); fibrinolysis (HR, 0.61, p<0.001); cardiogenic shock (HR, 0.60, p=0.023); statin (HR, 3.01, p<0.001), beta-blocker (HR, 1.26, p=0.020), angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB) (HR, 1.37, p=0.001) at hospital discharge; and MI at follow-up (HR, 0.72, p=0.001). The probability of not working at the last contact ranged from 24.2% for patients with no variables, up to 80% for patients with six or more variables. CONCLUSIONS: In patients discharged after ACS, prior and in-hospital clinical variables, as well as the quality of care at discharge, have a great impact on the long-term probability of actively working.
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Nicolau et al. (2021) conducted a cohort in Acute coronary syndrome (n=1,632). Statin prescription at hospital discharge vs. No statin prescription at hospital discharge was evaluated on Actively working at the last contact (HR 3.01, 95% CI 2.43-3.71, p=<0.001). Statin prescription at hospital discharge was independently associated with a significantly higher probability of actively working in the long-term after acute coronary syndrome (HR 3.01).
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