Evidence-Based Therapy and Its Association With Workforce Detachment After First Hospitalization for Heart Failure

TY - JOUR

T1 - Evidence-Based Therapy and Its Association With Workforce Detachment After First Hospitalization for Heart Failure

AU - Rørth, Rasmus

AU - Fosbøl, Emil L

AU - Mogensen, Ulrik M

AU - Kragholm, Kristian

AU - Jhund, Pardeep S

AU - Petrie, Mark C

AU - Schou, Morten

AU - Gislason, Gunnar H

AU - McMurray, John J V

AU - Torp-Pedersen, Christian

AU - Køber, Lars

AU - Kristensen, Søren L

N1 - Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2018/1

Y1 - 2018/1

N2 - OBJECTIVES: This study investigated the association between the use of evidence-based medicine (EBM) for heart failure (HF) and risk of workforce detachment.BACKGROUND: The ability to work can be a marker of functional capacity and quality of life.METHODS: We examined a nationwide cohort of patients in the workforce 1 year after first hospitalization for HF. EBM was defined as treatment with β-blockers and renin angiotensin system inhibitors. The fraction of target dose (0 TO 1) for each drug was calculated. The sum of the fractions gave each patient a score between 0 and 2. Patients were stratified into 4 groups according to this score: group 4 score = 2 (target dose of both drugs); group 3 score <2 to >1; group 2 score ≤1 to >0.5; and group 1 score ≤0.5. The risk of subsequent workforce detachment was estimated in cause specific Cox regression models.RESULTS: One year after first HF hospitalization, 10,185 patients were part of the workforce, and 7,561 (74%) were in treatment with at least 1 of the components of EBM. During a median follow-up of 727 days, 2,698 individuals (36%) became detached from the workforce. Patients receiving more EBM had a significantly lower risk of workforce detachment compared with those receiving less EBM (group 4 hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.77 to 0.98; group 3 HR: 0.85; 95% CI: 0.77 to 0.94; and group 2 HR 0.92; 95% CI: 0.83 to 1.02), all compared to group 1.CONCLUSIONS: Patients in the workforce 1 year after first HF hospitalization and treated with target or near-target doses of EBM were associated with a significantly lower risk of subsequent workforce detachment.

AB - OBJECTIVES: This study investigated the association between the use of evidence-based medicine (EBM) for heart failure (HF) and risk of workforce detachment.BACKGROUND: The ability to work can be a marker of functional capacity and quality of life.METHODS: We examined a nationwide cohort of patients in the workforce 1 year after first hospitalization for HF. EBM was defined as treatment with β-blockers and renin angiotensin system inhibitors. The fraction of target dose (0 TO 1) for each drug was calculated. The sum of the fractions gave each patient a score between 0 and 2. Patients were stratified into 4 groups according to this score: group 4 score = 2 (target dose of both drugs); group 3 score <2 to >1; group 2 score ≤1 to >0.5; and group 1 score ≤0.5. The risk of subsequent workforce detachment was estimated in cause specific Cox regression models.RESULTS: One year after first HF hospitalization, 10,185 patients were part of the workforce, and 7,561 (74%) were in treatment with at least 1 of the components of EBM. During a median follow-up of 727 days, 2,698 individuals (36%) became detached from the workforce. Patients receiving more EBM had a significantly lower risk of workforce detachment compared with those receiving less EBM (group 4 hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.77 to 0.98; group 3 HR: 0.85; 95% CI: 0.77 to 0.94; and group 2 HR 0.92; 95% CI: 0.83 to 1.02), all compared to group 1.CONCLUSIONS: Patients in the workforce 1 year after first HF hospitalization and treated with target or near-target doses of EBM were associated with a significantly lower risk of subsequent workforce detachment.

U2 - 10.1016/j.jchf.2017.09.019

DO - 10.1016/j.jchf.2017.09.019

M3 - Journal article

C2 - 29226811

SN - 2213-1779

VL - 6

SP - 41

EP - 48

JO - JACC. Heart failure

JF - JACC. Heart failure

IS - 1

ER -