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Abstract
Introduction
Unemployment is associated with a 50% higher risk of death in patients with heart
failure, according to research presented recently at Heart Failure 2017 and the 4th
World Congress on Acute Heart Failure. The observational study in more than 20 000
heart-failure patients found that not being employed was linked with a greater likelihood
of death than a history of diabetes or stroke.
‘The ability to hold a job brings valuable information on wellbeing and performance
status’, said lead author Dr Rasmus Roerth, a physician at Copenhagen University Hospital,
Denmark. ‘And workforce exclusion has been associated with increased risk of depression,
mental health problems and even suicide.’
‘In younger patients with heart failure, employment status could be a potential predictor
of morbidity and mortality’, he continued. ‘If that was the case, employment status
could help to risk stratify young heart-failure patients and identify those needing
more intensive rehabilitation.’
This study compared the risks of all-cause death and recurrent heart-failure hospitalisation
in patients with heart failure, according to whether they were employed at baseline
or not. Using the unique personal identification number assigned to all residents
in Denmark, individual data were linked from nationwide registries on hospitalisation,
prescribed medication, education level, public welfare payments and death.
The study included all patients of working age (18 to 60 years) with a first hospitalisation
for heart failure in Denmark between 1997 and 2012. Of the 21 455 patients with a
first hospitalisation for heart failure, 11 880 (55%) were part of the workforce at
baseline.
During an average follow up of 1 005 days, 16% of employed and 31% of unemployed patients
died, while 40% of employed and 42% of unemployed patients were rehospitalised for
heart failure.
After adjusting for age, gender, education level and co-morbidities, heart-failure
patients unemployed at baseline had a 50% increased risk of death and 12% increased
risk of rehospitalisation for heart failure compared to those who were employed. Not
being part of the workforce was associated with a higher likelihood of death than
a history of diabetes or stroke.
Dr Roerth said: ‘We found that heart-failure patients out of the workforce at baseline
had a higher risk of death. Not being part of the workforce was associated with a
risk of death comparable to that of having diabetes or stroke. Those without a job
also had an increased risk of recurrent heart-failure hospitalisation.’
Dr Roerth said the exact mechanism on how employment status may affect mortality is
complex and most likely multifactorial. ‘The ability to work can be seen as a measure
of performance status and be interpreted as whether patients meet the physical requirements
of a full time job or not’, he said.
But he added: ‘Employment status is more than just a physical measurement as it also
has an influence on quality of life, and has been shown to be important for mental
health and wellbeing. Thus, both from a physical and psychological point of view it
makes sense to include employment status in the evaluation of young heart-failure
patients’ prognosis.’
Dr Roerth said it was perhaps not surprising that employment status has importance
for prognosis. ‘But the observation that employment status is associated with an increased
risk of death comparable to that of many other co-morbidities such as diabetes and
stroke is notable’, he said.
In terms of implications of the findings, Dr Roerth said workforce exclusion could
be used to identify heart failure patients at risk of poor outcomes and that efforts
to get patients back into work might be beneficial.
He said: ‘It could be highly valuable to assess employment status and actually think
of workforce exclusion as a prognostic marker in line with suffering from serious
chronic diseases. Knowledge on why workforce exclusion has happened for the individual
patient might lead to ideas on how it can be prevented – for example with more intensive
rehabilitation, physical activity, psychological treatment, or a different job.’
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