Optimising return to work for cardiovascular patients: an interdisciplinary approach in occupational medicine and cardiology

Background Cardiovascular disease (CVD) is the leading cause of death worldwide. Progressive improvements in diagnostic and therapeutic procedures, coupled with primary and secondary prevention, have led to a reduction in mortality and, consequently, an increase in the chronicity of these patients. This has implications not only for public health but also for employment, particularly in view of the gradual increase in the retirement age. Purpose Interdisciplinary collaboration between occupational medicine and cardiology is essential to develop protocols that optimise patients' return to work (RTW), adapt to their residual capacity and minimise work-related risks. The first step is to identify potential predictive factors, both positive and negative. By taking these into account and using appropriate diagnostic tests and possible workplace surveillance, occupational health consultants can assess fitness for work and facilitate a safe RTW. Methods Patients of working-age, discharged from Cardiology and Cardiosurgery unit of Trieste in 2024, following an acute CV event or a planned CV intervention were recruited for this study. Socio-demographic, clinical and occupational data, were collected. Furthermore, perception of RTW readaptation was assessed by Work Ability Index (WAI), whereas quality of life was assessed by EuroQoL (EQ-5D-5L) questionnaire. Task-specific heart rate and metabolic equivalent of the task (MET) were overestimated by the exercise test in relation to the respective work task. Results Sixty patients have been collected in the present (ongoing) study, with a mean age of 57.4 years. 88.3% of the patients were male, 38.3% were smokers, 28.3% ex-smokers, the mean BMI was 26.7±3.9, 41.7% were overweight and 21.7% obese. 16.7% of patients had diabetes, 53.3% hypertension and 80% dyslipidaemia. 50 patients (83.3%) had diagnosis of coronary artery disease (30 STEMI, 20 NSTEMI), 44 treated with PCI and 10 coronary by-pass graft, 6.7% had valvular heart disease, 18.3% with heart failure. After discharge, 30.4% still had non-target LDL and 4.2% stopped smoking. Approximately 5 months after the CV event, 20% of patients had not returned to work. Time to RTW increased with age, bypass surgery, heart failure, high metabolic equivalent of task (MET), rehabilitation programme, and decreased in self-employed patients. 11.1% exhibited a poor WAI (<28), 11.1% excellent (>43). On RTW the mean QoL was 0.732 ± 0.182, while the mean visual analogue scale (EQ-VAS) was 57.5 ± 9.7. The mood aspect of the questionnaire was partially objectified by subsequent emergency hospital visits (11, of which 9 were negative), highlighting the importance of the emotional component and the anxiety associated with the occurrence of a new event. Conclusion Identification of factors influencing RTW supports the reintegration CV patients in the workplace, maintenance of their productivity, thereby reducing indirect costs and protecting their health in the long run.