Adverse Change in Employment Status After Acute Myocardial Infarction: Analysis From the TRANSLATE-ACS Study.
Adverse Change in Employment Status After Acute Myocardial Infarction: Analysis From the TRANSLATE-ACS Study.
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急性心肌梗塞后就业状况的不利变化：翻译-ACS研究的分析。
DOI：
10.1161/circoutcomes.117.004528
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发表时间：
2018-06
期刊：
影响因子：
--
通讯作者：
Wang TY
中科院分区：
文献类型：
--
作者：
Warraich HJ;Kaltenbach LA;Fonarow GC;Peterson ED;Wang TY
急性心肌梗死（MI）后无法恢复工作对患者有重要意义。我们试图评估美国国家队列中心肌梗死后与就业不利变化相关的患病率和结果。TRANSLATE-ACS研究评估了美国233家医院的9319名心肌梗死患者（平均年龄60.8岁，标准差[SD] 11.3，女性27.3%）基线和1年的就业状况。我们将不良就业变化定义为患者在基线工作，但在心肌梗死后1年工作减少或不工作。在多变量模型中，我们评估了与就业不利变化相关的因素及其与患者报告的抑郁、健康状况、出院时坚持服用循证药物以及负担药物的经济困难之间的关系。一半的患者（51%,n= 4730）在心肌梗死时有工作。1年后，其中10% （n=492）的患者报告工作发生了不利变化，3% （n=143）的工作减少，7% （n=349）不再工作（349人中只有27人报告退休）。与就业不利变化显著相关的因素包括意外再入院人数、出院后出血并发症、高血压和吸烟。1年后，工作发生不利变化的患者更有可能报告抑郁（患者健康问卷-2评分bbbb3: 27.4%对16.7%），健康状况较差（平均EuroQoL视觉模拟量表：73 [SD 17.8]对78 [SD 14.8]）和中度极端经济困难（41.0%对28.4%）（均p<0.001）。在出院时坚持服用循证药物方面没有差异。在心肌梗死后经历不利就业变化的患者报告生活质量下降，抑郁增加，更难以负担药物。这些结果强调需要采取干预措施来解决这种以患者为中心的结果及其对健康的影响。ClinicalTrials.gov;唯一标识符：NCT01088503
Inability to resume employment after acute myocardial infarction (MI) has important implications for patients. We sought to assess the prevalence of and outcomes associated with adverse change in employment after MI in a national US cohort. The TRANSLATE-ACS study assessed employment status at baseline and 1 year among 9,319 MI patients (mean age 60.8 years, standard deviation [SD] 11.3; 27.3% female) enrolled at 233 US hospitals. We defined adverse change in employment as patients working at baseline but working less or not working at 1 year post-MI. In multivariable models, we assessed factors associated with adverse change in employment and its association with patient-reported depression, health status, persistence to evidence-based medications prescribed at discharge and financial hardship affording medications. Half of patients (51%, n=4,730) were employed at the time of MI. By 1 year, 10% (n=492) of these reported an adverse change in employment, with 3% (n=143) working less and 7% (n=349) no longer working (only 27 of 349 reported retirement). Factors significantly associated with adverse change in employment included number of unplanned readmissions, post-discharge bleeding complications, hypertension, and smoking. At 1 year, patients with an adverse change in employment were more likely to report depression (Patient Health Questionnaire-2 score >3: 27.4% vs. 16.7%), lower health status (mean EuroQoL visual analogue scale: 73 [SD 17.8] vs. 78 [SD 14.8]) and moderate-extreme financial hardship with medication costs (41.0% vs. 28.4%) (all p<0.001). There was no difference in persistence to evidence-based medications prescribed at discharge. Patients who experienced an adverse change in employment after MI reported lower quality of life, increased depression and more difficulty affording medications. These results underscore the need for interventions to address this patient-centered outcome and its health impact. ClinicalTrials.gov; Unique Identifier: NCT01088503
影响因子：
3.8
作者：
Kronish, Ian M.;Rieckmann, Nina;Burg, Matthew M.;Alcantara, Carmela;Davidson, Karina W.
通讯作者：
Davidson, Karina W.