Author + information
- Received May 10, 2017
- Revision received September 14, 2017
- Accepted September 19, 2017
- Published online December 25, 2017.
- Rasmus Rørth, MDa,∗ (, )
- Emil L. Fosbøl, MD, PhDa,
- Ulrik M. Mogensen, MD, PhDa,b,
- Kristian Kragholm, MD, PhDc,
- Pardeep S. Jhund, MBChB, MSc, PhDb,
- Mark C. Petrie, MBChBb,
- Morten Schou, MD, PhDd,
- Gunnar H. Gislason, MD, PhDd,e,f,
- John J.V. McMurray, MDb,
- Christian Torp-Pedersen, MD, DMScc,g,
- Lars Køber, MD, DMSca and
- Søren L. Kristensen, MD, PhDa,b
- aDepartment of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- bBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- cDepartments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- dDepartment of Cardiology, Herlev and Gentofte University Hospital, Herlev/Hellerup, Denmark
- eThe Danish Heart Foundation, Copenhagen, Denmark
- fThe National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- gDepartment of Health, Science and Technology, Aalborg University, Aalborg, Denmark
- ↵∗Address for correspondence:
Dr. Rasmus Rørth, Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
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.
Dr. Kragholm has received speaker fees from Novartis; and a grant from The Laerdal Foundation. Dr. Torp-Pedersen has received grants and speaker fees from Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 10, 2017.
- Revision received September 14, 2017.
- Accepted September 19, 2017.
- 2018 American College of Cardiology Foundation
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