title: Work-related outcome after acute coronary syndrome: Implications of complex cardiac rehabilitation in occupational medicine.
abstract: OBJECTIVE
  Coronary heart disease is frequent in the working-age population. Traditional outcomes, such as mortality and hospital readmission, are useful for evaluating prognosis. Fit-for-work is an emerging outcome with clinical as well as socioeconomic significance. We describe the possible benefit of a cardiac rehabilitation (CR) program for return to work (RTW) after acute coronary syndrome (ACS).
  
  
  METHODS
  We evaluated 204 patients with recent ACS. They were divided into 4 groups on the basis of their occupational work load: very light (VL), light (L), moderate (M), and heavy (H). Work-related outcomes were assessed with the Work Performance Scale (WPS) of the Functional Status Questionnaire and as "days missed from work" (DMW) in the previous 4 weeks. The variables considered for outcomes were percent ejection fraction, functional capacity expressed in metabolic equivalents (METs), and participation or non-participation in the CR program (CR+ and CR-).
  
  
  RESULTS
  One hundred thirty (66%) patients took part in the CR program. Total WPS scores for CR+ and CR- subgroups were VL group: 18±4 vs. 14±4 (p < 0.001), L group: 18±3 vs. 14±3 (p < 0.0001), M group: 19±3 vs. 16±3 (p < 0.003), and H group: 20±4 vs. 17±3 (p < 0.006). Fewer DMW were reported by the CR+ group.
  
  
  CONCLUSIONS
  Non-participation in CR was a consistent cause of poorer work-related outcomes. Our findings indicate that CR and occupational counseling play a very important role in worker recovery and subsequent reintegration in the workplace, in particular among clerical workers.
authors.affiliation: Second University of Naples, Naples, Italy (Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, School of Medicine). monica.lamberti@unina2.it.
authors.forename: Monica
authors.initials: M
authors.lastname: Lamberti
authors.affiliation: S. Giovanni Bosco Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Intensive Care Unit).
authors.forename: Gennaro
authors.initials: G
authors.lastname: Ratti
authors.affiliation: Second University of Naples, Naples, Italy (Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, School of Medicine).
authors.forename: Donato
authors.initials: D
authors.lastname: Gerardi
authors.affiliation: S. Giovanni Bosco Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Intensive Care Unit).
authors.forename: Cristina
authors.initials: C
authors.lastname: Capogrosso
authors.affiliation: S. Gennaro Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Cardiac Rehabilitation).
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ricciardi
authors.affiliation: S. Gennaro Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Cardiac Rehabilitation).
authors.forename: Cosimo
authors.initials: C
authors.lastname: Fulgione
authors.affiliation: S. Gennaro Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Cardiac Rehabilitation).
authors.forename: Salvatore
authors.initials: S
authors.lastname: Latte
authors.affiliation: S. Giovanni Bosco Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Intensive Care Unit).
authors.forename: Paolo
authors.initials: P
authors.lastname: Tammaro
authors.affiliation: S. Giovanni Bosco Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Intensive Care Unit).
authors.forename: Gregorio
authors.initials: G
authors.lastname: Covino
authors.affiliation: University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Institute for Health Services Research in Dermatology and Nursing).
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus
authors.affiliation: Second University of Naples, Naples, Italy (Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, School of Medicine).
authors.forename: Elpidio Maria
authors.initials: EM
authors.lastname: Grazillo
authors.affiliation: S. Gennaro Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Cardiac Rehabilitation).
authors.forename: Mario
authors.initials: M
authors.lastname: Mallardo
authors.affiliation: S. Giovanni Bosco Hospital, Naples 1 Local Health Unit, Naples, Italy (Cardiology/Intensive Care Unit).
authors.forename: Paolo
authors.initials: P
authors.lastname: Capogrosso
mesh_terms: D000041:Absenteeism; D054058:Acute Coronary Syndrome / Q000150:complications / Q000534:rehabilitation*; D000328:Adult; D001007:Anxiety / Q000209:etiology; D000072038:Cardiac Rehabilitation; D003863:Depression / Q000209:etiology; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009787:Occupational Medicine; D063868:Patient Outcome Assessment; D011788:Quality of Life; D062707:Return to Work / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data
keywords: acute coronary syndrome; anxiety; counseling; depression; rehabilitation; workers