Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017 200 AFRICA
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Unemployment associated with 50% higher risk of death in heart-failure patients
Unemployment is associated with a 50% higher risk of death
in patients with heart failure, according to research presented
recently at Heart Failure 2017 and the 4th World Congress on
Acute Heart Failure. The observational study in more than
20 000 heart-failure patients found that not being employed
was linked with a greater likelihood of death than a history of
diabetes or stroke.
‘The ability to hold a job brings valuable information on
wellbeing and performance status’, said lead author Dr Rasmus
Roerth, a physician at CopenhagenUniversity Hospital, Denmark.
‘And workforce exclusion has been associated with increased risk
of depression, mental health problems and even suicide.’
‘In younger patients with heart failure, employment status
could be a potential predictor of morbidity and mortality’, he
continued. ‘If that was the case, employment status could help
to risk stratify young heart-failure patients and identify those
needing more intensive rehabilitation.’
This study compared the risks of all-cause death and
recurrent heart-failure hospitalisation in patients with heart
failure, according to whether they were employed at baseline or
not. Using the unique personal identification number assigned
to all residents in Denmark, individual data were linked from
nationwide registries on hospitalisation, prescribed medication,
education level, public welfare payments and death.
The study included all patients of working age (18 to 60
years) with a first hospitalisation for heart failure in Denmark
between 1997 and 2012. Of the 21 455 patients with a first
hospitalisation for heart failure, 11 880 (55%) were part of the
workforce at baseline.
During an average follow up of 1 005 days, 16% of employed
and 31% of unemployed patients died, while 40% of employed and
42% of unemployed patients were rehospitalised for heart failure.
After adjusting for age, gender, education level and
co-morbidities, heart-failure patients unemployed at baseline
had a 50% increased risk of death and 12% increased risk of
rehospitalisation for heart failure compared to those who were
employed. Not being part of the workforce was associated with
a higher likelihood of death than a history of diabetes or stroke.
Dr Roerth said: ‘We found that heart-failure patients out
of the workforce at baseline had a higher risk of death. Not
being part of the workforce was associated with a risk of death
comparable to that of having diabetes or stroke. Those without
a job also had an increased risk of recurrent heart-failure
hospitalisation.’
Dr Roerth said the exact mechanism on how employment
status may affect mortality is complex and most likely
multifactorial. ‘The ability to work can be seen as a measure of
performance status and be interpreted as whether patients meet
the physical requirements of a full time job or not’, he said.
But he added: ‘Employment status is more than just a physical
measurement as it also has an influence on quality of life, and
has been shown to be important for mental health and wellbeing.
Thus, both from a physical and psychological point of view it
makes sense to include employment status in the evaluation of
young heart-failure patients’ prognosis.’
Dr Roerth said it was perhaps not surprising that employment
status has importance for prognosis. ‘But the observation that
employment status is associated with an increased risk of
death comparable to that of many other co-morbidities such as
diabetes and stroke is notable’, he said.
In terms of implications of the findings, Dr Roerth said
workforce exclusion could be used to identify heart failure
patients at risk of poor outcomes and that efforts to get patients
back into work might be beneficial.
He said: ‘It could be highly valuable to assess employment
status and actually think of workforce exclusion as a prognostic
marker in line with suffering from serious chronic diseases.
Knowledge on why workforce exclusion has happened for the
individual patient might lead to ideas on how it can be prevented
– for example with more intensive rehabilitation, physical
activity, psychological treatment, or a different job.’
Source: European Society of Cardiology Press Office