From the Journals

Depression follows job loss after acute MI

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Improvements still needed in patient-centered care

The results of this study are promising, as previous research has shown up to 51% adverse change in employment status at 1-year follow-up.

Nevertheless, the rate of work loss reported in this study requires continued improvements to patient-centered care. Providing such care requires a shift that recognizes that the success of treatments is dependent on patients not only adhering to treatments but also actively engaging in their own self-care.

The U.S. workforce is aging, with a 72% increase since 2000 in the number of workers 55 years and older. Nearly half the workforce is female, and racial and ethnic minority groups make up 25% of it. These same populations experience poorer cardiovascular outcomes after AMI, highlighting the importance of incorporating patient preferences about return to work and continued employment into patient care planning.

Moving forward, future work is required to understand the barriers to successful return to work for these patients. The need for interventions that support successful return to work requires continued attention by researchers and clinicians.

Rachel P. Dreyer, PhD, of Yale University in New Haven, Conn., and Victoria Vaughan Dickson, PhD, of New York University, made these comments in an editorial published with the study (Circ Cardiovasc Qual Outcomes. 2018 Jun 12. doi: 10.1161/circoutcomes.118.004806.)



Patients who experienced adverse changes in employment status after acute myocardial infarction (AMI) reported increased depression and lower quality of life, according to results published June 12 in Circulation: Cardiovascular Quality and Outcomes.

At 1-year follow-up, 27.4% of patients with adverse employment change scored high on measures of depression, compared with 16.7% of patients who did not experience a change in status. These patients also reported lower health status and difficulty affording medications, wrote Haider J. Warraich, MD, a cardiologist at Duke University in Durham, N.C., and coauthors.

Dr. Haider J. Warraich, a cardiologist at Duke University in Durham, N.C.

Dr. Haider J. Warraich

The authors assessed 9,319 AMI patients from the TRANSLATE-ACS (Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) study, which included adults enrolled in 233 U.S. hospitals between April 2010 and October 2012. Patients presented with either ST-segment–elevation myocardial infarction (STEMI) or non-STEMI, treated with percutaneous coronary intervention and a P2Y12 inhibitor.

Baseline data were collected for all patients according to CathPCI Registry standards, and follow-up was conducted via telephone 6 weeks, 6 months, 1 year, and 15 months after discharge. After 1 year, patients who reported working full or part time were defined as working. Adverse change in employment was defined as those who “reported working immediately before the index MI hospitalization but were either no longer working or working fewer hours,” Dr. Warraich and his colleagues reported.

Depression was defined by a Patient Health Questionnaire (PHQ) score greater than 3. Health status was assessed using the EuroQoL-5 Dimensions (EQ-5D) visual analog scale. Medication adherence was assessed using three questions at the follow-up interview, and patients were also asked to rank the financial hardship of their monthly medication costs on a scale of 1-5.

Among patients working at baseline, 492 (10%) reported an adverse change in employment after a year. Of these, 349 (7%) were no longer working, and 143 (3%) were working less than before. Of those with an adverse change in employment, 172 reported involuntary job loss such as being laid off or no longer working due to health concerns. Just 27 patients reported retirement.

The number of readmissions within the first year was the factor most strongly associated with adverse change in employment. Baseline smoking status, hypertension, and postdischarge bleeding were also significantly associated with adverse change in employment, the authors said.

At 1 year follow-up, patients with an adverse change in employment were more likely than those with no change to report depression (27.4% with PHQ score greater than 3, compared with 16.7% in the no-change group). These patients also reported lower health status (mean EuroQoL score of 73 compared with 78) and moderate to extreme financial hardship with medication costs (41.0% compared with 28.4%), though there was no difference in medication adherence, the authors reported.

The results indicate that, although job loss in acute MI patients has dropped in comparison with previous studies, patients who experience an adverse change in employment are still “at increased risk of depression, lower quality of life, and increased financial hardship with medication costs compared with those who continue working,” the authors wrote.

“These results underscore the need for interventions to address this patient-centered outcome and its health impact,” they concluded.

Daiichi Sankyo and Lilly USA funded TRANSLATE-ACS. This analysis was funded in part by a grant from the National Heart, Lung, and Blood Institute.

SOURCE: Warraich H et al. Circ Cardiovasc Qual Outcomes. 2018 Jun 12. doi: 10.1161/circoutcomes.117.004528.

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