title: Impact of health care system delay in patients with ST-elevation myocardial infarction on return to labor market and work retirement.
abstract: System delay (delay from emergency medical service call to reperfusion with primary percutaneous coronary intervention [PPCI]) is acknowledged as a performance measure in ST-elevation myocardial infarction (STEMI), as shorter system delay is associated with lower mortality. It is unknown whether system delay also impacts ability to stay in the labor market. Therefore, the aim of the study was to evaluate whether system delay is associated with duration of absence from work or time to retirement from work among patients with STEMI treated with PPCI. We conducted a population-based cohort study including patients ≤67 years of age who were admitted with STEMI from January 1, 1999, to December 1, 2011 and treated with PPCI. Data were derived from Danish population-based registries. Only patients who were full- or part-time employed before their STEMI admission were included. Association between system delay and time to return to the labor market was analyzed using a competing-risk regression analysis. Association between system delay and time to retirement from work was analyzed using a Cox regression model. A total of 4,061 patients were included. Ninety-three percent returned to the labor market during 4 years of follow-up, and 41% retired during 8 years of follow-up. After adjustment, system delay >120 minutes was associated with reduced resumption of work (subhazard ratio 0.86, 95% confidence interval 0.81 to 0.92) and earlier retirement from work (hazard ratio 1.21, 95% confidence interval 1.08 to 1.36). In conclusion, system delay was associated with reduced work resumption and earlier retirement. This highlights the value of system delay as a performance measure in treating patients with STEMI.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: kristina@laut.dk.
authors.forename: Kristina Grønborg
authors.initials: KG
authors.lastname: Laut
authors.affiliation: Department of Public Health and Quality Improvement, Central Region Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Hjort
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.affiliation: Department of Cardiology, Odense University Hospital, Odensen, Denmark.
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Tilsted Hansen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Alma Becic
authors.initials: AB
authors.lastname: Pedersen
authors.affiliation: Prehospital Emergency Medical Service, The Central Denmark Region, Denmark.
authors.forename: Erika Frischknecht
authors.initials: EF
authors.lastname: Christensen
authors.affiliation: Prehospital Emergency Medical Service, The Capital Region of Denmark, Denmark.
authors.forename: Freddy
authors.initials: F
authors.lastname: Lippert
authors.affiliation: Prehospital Emergency Medical Service, The South Denmark Region, Denmark.
authors.forename: Torsten
authors.initials: T
authors.lastname: Lang-Jensen
authors.affiliation: Prehospital Emergency Medical Service, Region Zealand, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Jans
authors.affiliation: Prehospital Emergency Medical Service, The North Denmark Region, Denmark.
authors.forename: Poul Anders
authors.initials: PA
authors.lastname: Hansen
authors.affiliation: Falck Emergency Medical Service, Copenhagen, Denmark.
authors.forename: Sven
authors.initials: S
authors.lastname: Trautner
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
authors.forename: Steen Dalby
authors.initials: SD
authors.lastname: Kristensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Lash
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
mesh_terms: D003695:Delivery of Health Care; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods; D011379:Prognosis; D012042:Registries; D012179:Retirement / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062707:Return to Work / Q000706:statistics & numerical data*; D013997:Time Factors