Return to work following adverse cardiovascular events in adults with congenital heart disease

Background: Adults with congenital heart disease (CHD) are at increased risk for major adverse cardiovascular events (MACE), including stroke, myocardial infarctions, and heart failure. Following survival of MACE, an important metric is re-entry to the workforce. This study sought to characterize the differences in return-to-work (RTW) characteristics between MACE survivors with CHD and those in the general population. Methods: Linking Danish health and administrative registries, a cohort of adults with CHD who survived a MACE between the years of 1992–2017 were matched 10:1 by age at MACE, year of MACE, and sex to MACE survivors without CHD. Logistic regression assessed working status relative risk at three-, six-, and 12- months after the MACE event. Cox regression hazard ratio characterized time to RTW and maintained RTW. Results: During the study period, 538 CHD patients survived MACE. These patients were matched to 4930 MACE survivors without CHD. The adjusted odds ratios of having returned to work were 0.91 (95% confidence interval (CI): 0.73–1.14) of employment at three months, 0.77 (95% CI: 0.61–0.96) at six months, and 0.76 (95% CI: 0.61–0.96) at 12 months. Of those who required governmental disability payments after MACE and admission for longer than one day, the adjusted hazard ratio of maintained RTW was 0.83 (95% CI: 0.69–0.99) for CHD patients compared to the general population. Conclusions: Patients with CHD who survive a MACE have evidence of impaired RTW compared to those without CHD. Further research is needed to understand and augment functional recovery in this complex population.