Introduction: Inability to resume work after acute myocardial infarction (MI) has important implications for patients, potentially reducing their ability to afford medications, and resulting in depression, and lower quality of life.
Methods: We examined employment status at baseline and 1 year among 9,319 MI patients in the TRANSLATE-ACS study enrolled at 233 US hospitals. In multivariable models, we assessed factors associated with adverse change in work status (job loss/work less hours) and its association with financial hardship affording medications, self-rated health status (EuroQol visual analogue scale) and depression (Patient Health Questionnaire-2).
Results: Half of patients (51%, n=4,730) were employed at the time of their acute MI. By 1 year, 10% (n=492) of these reported an adverse change in work status, with 3% (n=143) working less and 7% (n=349) no longer working (only 27 of 349 reported retirement). Significant factors associated with adverse change in employment included number of unplanned readmissions within the first year (OR 1.20, 95% CI 1.09-1.32 per event), bleeding complications post-stenting (1.39 (1.13-1.72)), hypertension (1.33 (1.08-1.65)), and smoking (1.28 (1.04-1.57)). At 1 year, patients with and without adverse employment change reported similar out of pocket medication costs yet patients with an adverse change were more likely to report financial hardship with medication costs. Additionally, adverse change in employment was associated with increased depression (PHQ2 >3) and lower quality of life (lower EuroQol score) (Table).
Discussion: While an adverse change in employment after MI is not common, patients who do experience it have more difficulty affording medications, higher risk for depression and lower quality of life.