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Canadian Journal of Cardiology

Complex Determinants of Work Ability in Adults With Congenital Heart Disease and Implications for Clinical Practice

Published:November 07, 2019DOI:https://doi.org/10.1016/j.cjca.2019.11.003

      Abstract

      Background

      “Work ability” is the employees’ capacity to meet the demands of their job. As more patients with complex congenital heart disease (CHD) are now reaching adulthood, we assessed work ability and factors impacting livelihood in adult CHD.

      Methods

      The work ability index (WAI) questionnaire and patient health questionnaire-9 (PHQ-9) were administered at 2 Midwest adult CHD centres from February 2017 to 2018.

      Results

      Of the 267 participants (n = 157 males, 59%) with an average age of 35 ± 13 years, the majority (n = 204, 76%) were employed. Patients with complex CHD (n = 103, 39%) were less likely to have enrolled in college or completed a graduate degree (P = 0.0115), and more likely to have an annual income of < $50,000 (P = 0.0056) and lower WAI scores (P = 0.0026) than patients with simple and moderate CHD. Unemployed patients (n = 63, 24%) with complex CHD (n = 27, 43%) were more likely to have higher PHQ-9 scores (P = 0.0242) indicating mild, moderate, or severe depression (P = 0.0482) than unemployed patients with simple and moderate CHD. Patients with complex CHD had lower self-perception of work ability compared with patients with simple and moderate CHD (P = 0.0007). Finally, patients in NYHA Functional Class I had higher WAI scores than NYHA Class III-IV (P < 0.0001).

      Conclusions

      This study demonstrates that employed patients with complex CHD have lower education level, income, and work ability. Unemployed patients are more likely to exhibit symptoms of depression and have low self-perception of work ability. Occupational health programs focusing on promoting general health perception, increasing exercise capacity, and improving psychosocial health must be considered to improve work ability in patients with adult CHD to maintain livelihood.

      Résumé

      Introduction

      L’« aptitude au travail » signifie la capacité du personnel à répondre aux exigences de leur emploi. Puisque plus de patients atteints d’une cardiopathie congénitale (CC) complexe sont parvenus à l’âge adulte, nous avons évalué leur aptitude au travail et les facteurs qui se répercutent sur le gagne-pain des adultes atteints d’une CC.

      Méthodes

      De février 2017 à 2018, des adultes de 2 centres de CC pour adultes du Midwest ont répondu au questionnaire sur l’indice d’aptitude au travail (IAT) et au Patient Health Questionnaire-9 (PHQ-9).

      Résultats

      Parmi les 267 participants (n = 157 hommes, 59 %) dont l’âge moyen était de 35 ± 13 ans, la majorité (n = 204, 76 %) travaillait. Il était moins probable que les patients atteints d’une CC complexe (n = 103, 39 %) soient inscrits dans un établissement d’enseignement supérieur ou qu’ils aient complété un diplôme d’études supérieures (P = 0,0115), et plus probable qu’ils aient un revenu annuel de < 50 000 $ (P = 0,0056) et des scores plus faibles à l’IAT (P = 0,0026) que les patients atteints d’une CC simple ou modérée. Il était plus probable que les patients sans emploi (n = 63, 24 %) atteints d’une CC complexe (n = 27, 43 %) aient des scores au PHQ-9 plus élevés (P = 0,0242) qui montrent une dépression légère, modérée ou grave (P = 0,0482) que les patients sans emploi atteints d’une CC simple ou modérée. Les patients atteints d’une CC complexe avaient une autoperception plus faible de leur aptitude au travail que les patients atteints d’une CC simple ou modérée (P = 0,0007). Enfin, les patients appartenant à la classe I de la classification fonctionnelle de la NYHA avaient des scores plus élevés à l’IAT que les patients des classes III et IV (P < 0,0001).

      Conclusions

      La présente étude démontre que les patients atteints d’une CC complexe qui travaillent ont un niveau de scolarité, un revenu et une aptitude au travail plus faibles. Il est plus probable que les patients qui ne travaillent pas montrent des symptômes de dépression et aient une autoperception plus faible de leur aptitude au travail. Les programmes de santé professionnelle qui portent sur la promotion de la perception de la santé générale, l’augmentation de la capacité à l’effort et l’amélioration de la santé psychosociale doivent être considérés pour améliorer l’aptitude au travail des patients adultes atteints d’une CC et leur permettre de conserver leur gagne-pain.
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