The importance of return to work – How to achieve optimal reintegration in ACS patients

Abstract

The vocational reintegration of patients who have experienced an acute coronary syndrome (ACS) is a crucial step towards complete convalescence from the social as well as individual point of view. Return-to-work rates are determined by medical parameters such as left ventricular function, residual ischemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts, and the ability to commute (which is, in part, determined by the physical fitness). Psychosocial factors including depression, self-perceived health situation, and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. Comprehensive health care pathway of ACS patients should be initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients suffering an ACS and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action initiated by the Working Group of Secondary Prevention and Rehabilitation of the European Association of Preventive Cardiology (EAPC).