Evaluation of a Structuralized Sick-Leave Programme Compared with usual Care Sick-Leave Management for Patients after an Acute Myocardial Infarction
Keywords:myocardial infarction, quality of life, sick leave
Objective: To compare a structuralized sick-leave programme with usual care sick-leave management in patients after an acute myocardial infarction. We hypothesize that a structured sick-leave programme will yield a faster return to work without negatively affecting quality of life.
Methods: Patients admitted to Oslo University Hospital due to an acute myocardial infarction were included in the study. Patients were randomized into an intervention group or a conventional care group. Patients randomized to the intervention group were provided with a standard programme with full-time sick leave for 2 weeks after discharge and then encouraged to return to work. The sick leave of the conventional group was mainly managed by their general practitioner.
Results: A total of 143 patients were included in the study. The conventional care group had a mean of 20.4 days absent from work, while that of the intervention group was significantly lower, with a mean of 17.2 days (p < 0.001) absent. There was no significant change in quality of life between the groups.
Conclusion: These findings strengthen the case for structuralized follow-up of patients with acute myocardial infarction, as this will have positive economic consequences for the patient and society as a whole, without making quality of life worse. Further investigation, with a larger study population, is warranted to determine the extent of health benefits conferred by early return to work.
This study aimed to compare a structuralized sick-leave programme with usual care sick-leave management in patients after an acute myocardial infarction. The study included 143 patients who were admitted to Oslo University Hospital due to an acute myocardial infarction. Patients were randomized to an intervention group or a conventional care group. The intervention group followed a standard programme with full-time sick leave for 2 weeks after discharge, and were then encouraged to return to work. Intervention group patients had access to a telephone number to contact a cardiologist for advice if needed. The sick leave of the conventional group was mainly managed by their general practitioner. The sick leave of the intervention group was, 3.2 days shorter, whereas there was no difference in quality of life between the groups. In conclusion, these results indicate potentially large positive economic consequences of a structuralized sick-leave programme for patients and for society as a whole, with no worsening in quality of life.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Executive summary: heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation 2014; 21: 399–410. DOI: https://doi.org/10.1161/01.cir.0000442015.53336.12
Kotseva K, Gerlier L, Sidelnikov E, Kutikova L, Lamotte M, Amarenco P, et al. Patient and caregiver productivity loss and indirect costs associated with cardiovascular events in Europe. Eur J Prev Cardiol 2019; 26: 1150–1157. DOI: https://doi.org/10.1177/2047487319834770
Kolloch R, Legler UF, Champion A, Cooper-Dehoff RM, Handberg E, Zhou Q, et al. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST). Eur Heart J 2008; 29: 1327–1334. DOI: https://doi.org/10.1093/eurheartj/ehn123
Girerd N, Magne J, Rabilloud M, Charbonneau E, Mohamadi S, Pibarot P, et al. The impact of complete revascularization on long-term survival is strongly dependent on age. Ann Thorac Surg 2012; 94: 1166–1172. DOI: https://doi.org/10.1016/j.athoracsur.2012.05.023
Hall TS, von Lueder TG, Zannad F, Rossignol P, Duarte K, Chouihed T, et al. Relationship between left ventricular ejection fraction and mortality after myocardial infarction complicated by heart failure or left ventricular dysfunction. Int J Cardiol 2018; 272: 260–266. DOI: https://doi.org/10.1016/j.ijcard.2018.07.137
Edwards K, Jones N, Newton J, Foster C, Judge A, Jackson K. et al. The cost-effectiveness of exercise-based cardiac rehabilitation: a systematic review of the characteristics and methodological quality of published literature. Health Econ Rev 2017; 19: 37. DOI: https://doi.org/10.1186/s13561-017-0173-3
Kavradim ST, Özer ZC. The effect of education and telephone follow-up intervention based on the Roy Adaptation Model after myocardial infarction: randomised controlled trial. Scand J Caring Sci 2020; 34: 247–260. DOI: https://doi.org/10.1111/scs.12793
Català Tella N, Serna Arnaiz C, Real Gatius J, Yuguero Torres O, Galván Santiago L. Assessment of the length of sick leave in patients with ischemic heart disease. BMC Cardiovasc Disord 2017; 17: 32. DOI: https://doi.org/10.1186/s12872-016-0460-7
Briffa TG, Eckermann SD, Griffiths AD, Harris PJ, Heath MR, Freedman SB, et al. The cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial. Med J Aust 2005; 183: 450–455. DOI: https://doi.org/10.5694/j.1326-5377.2005.tb07121.x
Seghieri C, Berta P, Nuti S. Geographic variation in inpatient costs for acute myocardial infarction care: insights from Italy. Health Policy 2019; 123: 449–456. DOI: https://doi.org/10.1016/j.healthpol.2019.01.010
Lilliehorn S, Hamberg K, Kero A, Salander P. Meaning of work and the returning process after breast cancer: a longitudinal study of 56 women. Scand J Caring Sci 2013; 27: 267–274. DOI: https://doi.org/10.1111/j.1471-6712.2012.01026.x
Mewes JC, Steuten LMG, Groeneveld IF, de Boer AGEM, Frings-Dresen MHW, Ijzerman M, et al. Return-to-work intervention for cancer survivors: budget impact and allocation of costs and returns in the Netherlands and six major EU-countries. BMC Cancer 2015; 15: 899. DOI: https://doi.org/10.1186/s12885-015-1912-7
Perk J, Alexanderson K. Swedish Council on Technology Assessment in Health Care (SBU). Chapter 8. Sick leave due to coronary artery disease or stroke. Scand J Public Health Suppl 2004; 63: 181–206. DOI: https://doi.org/10.1080/14034950410021880
Isaaz K, Coudrot M, Sarby MH, Cerisier A, Lamaud M, Robin C, et al. Return to work after acute ST-segment elevation myocardial infarction in the modern era of reperfusion by direct percutaneous coronary intervention. Arch Cardiovasc Dis 2010; 5: 310–316. DOI: https://doi.org/10.1016/j.acvd.2010.04.007
Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med 2004; 46: 398–412. DOI: https://doi.org/10.1097/01.jom.0000121151.40413.bd
Norwegian Directorate of Health (2016). Acute coronary infarction (K75) Oslo: Helsedirektoratet (updated 18. May 2017, retrieved 25. February 2022). Available from: https://www.helsedirektoratet.no/veiledere/sykmelderveileder/diagnosespesifikke-anbefalinger-for-sykmelding/hjerte-karsystemet-k/akutt-hjerteinfarkt-k75
Kim J, Shin W. How to do random allocation (randomization). Clin Orthop Surg 2014; 6: 103–109. DOI: https://doi.org/10.4055/cios.2014.6.1.103
Ware J, Sherbourne C. The MOS 36-Item Short-Form Health Survey (SF36). Med Care 1992; 30: 473–483. DOI: https://doi.org/10.1097/00005650-199206000-00002
Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ 1993; 306: 1437–1440. DOI: https://doi.org/10.1136/bmj.306.6890.1437
Martin AJ, Glasziou PP, Simes RJ. A cardiovascular extension of the Health Measurement Questionnaire. J Epidemiol Community Health 1999; 53: 548–557. DOI: https://doi.org/10.1136/jech.53.9.548
Babić Z, Pavlov M, Oštrić M, Milošević M, Misigoj Duraković M, Pintarić H. Re-initiating professional working activity after myocardial infarction in primary percutaneous coronary intervention networks era. Int J Occup Med Environ Health 2015; 28: 999–1010. DOI: https://doi.org/10.13075/ijomeh.1896.00478
Khot UN, Johnson MJ, Wiggins NB, Lowry AM, Rajeswaran J, Kapadia S, et al. Long-term time-varying risk of readmission after acute myocardial infarction. J Am Heart Assoc 2018; 7: e009650. DOI: https://doi.org/10.1161/JAHA.118.009650
Rymer JA, Chen AY, Thomas L, Fonarow GC, Peterson ED, Wang TY. Readmissions after acute myocardial infarction: how often do patients return to the discharging hospital? J Am Heart Assoc 2019; 8: e012059. DOI: https://doi.org/10.1161/JAHA.119.012059
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