title: Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany.
authors.forename: Annett
authors.initials: A
authors.lastname: Salzwedel
authors.affiliation: Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam, Germany.
authors.forename: Rona
authors.initials: R
authors.lastname: Reibis
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Eichler
authors.affiliation: Department of Cardiology, Klinik am See, Rüdersdorf, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Buhlert
authors.affiliation: Department of Cardiology, Klinik am See, Rüdersdorf, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kaminski
authors.affiliation: Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany. Heinz.Voeller@klinikamsee.com.|Department of Cardiology, Klinik am See, Rüdersdorf, Germany. Heinz.Voeller@klinikamsee.com.
authors.forename: Heinz
authors.initials: H
authors.lastname: Völler
mesh_terms: D003131:Combined Modality Therapy; D005080:Exercise Test; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D062707:Return to Work; D013997:Time Factors; D016896:Treatment Outcome; D014938:Work Capacity Evaluation
keywords: Cardiac rehabilitation; Coronary disease; Exercise capacity; Prognosis; Social medicine