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Heart attack, stroke tied to lost work and wages

(Reuters Health) – People who suffer a heart attack, stroke or cardiac arrest may be less likely to work afterward, and those who do work may make less money, a Canadian study suggests.

Survivors of sudden medical crises can experience lasting reductions in their quality of life and ability to complete daily tasks or perform work duties. For the current study, researchers examined hospitalization records and income tax data from 2005 to 2013 to see what happened to patients’ earnings after a major cardiovascular event.

All of the study subjects were 40 to 61 years old, were working over the two years prior to the event and were alive three years later. Researchers compared the earnings before and after the event for 19,129 heart attack survivors and 1.8 million similar people who didn’t have a heart attack, as well as 1,043 cardiac arrest survivors and 307,375 similar people who didn’t have a cardiac arrest and 4,395 stroke survivors and 888,481 similar individuals who didn’t have a stroke.

Compared to people who didn’t suffer any cardiovascular events, 5 percent fewer people who had heart attacks were working three years later, while 13 percent fewer cardiac arrest survivors and 20 percent fewer stroke survivors were still working, the analysis found.

For survivors still working, earnings dropped by an average of $3,834 Canadian dollars (US$2,872.82) for heart attack survivors, C$11,143 for cardiac arrest survivors and C$13,278 for stroke survivors, the researchers report in CMAJ.

“These losses in the ability to work and earn were greater for people who had lower income before the events, had more chronic medical disorders, and needed more or longer hospital care for their acute health events,” said lead study author Dr. Allan Garland of the University of Manitoba in Winnipeg.

“For those who are affected, the financial effects of such health events extend as far as causing bankruptcy,” Garland said by email. “Earnings losses can also start a sequence of events that can further worsen health.”

The effects on income were greatest for patients who had the lowest earnings to begin with and for people with the longest hospital stays.

Reasons for limited work ability or reduced earnings weren’t directly examined in the study.

However, with a heart attack it’s possible that a reduced ability of the heart to pump blood afterwards might limit a person’s ability to work because of reduced stamina for physical activity, Garland said.

When a stroke restricts blood and oxygen to a part of the brain, survivors might have problems afterwards with a variety of things depending on the affected region of the brain, Garland said. They might have difficulties with strength, coordination, vision or speech, all of which might limit their ability to work.

“The ability to go back to work also depends the type of work that the person did,” Garland said. “For example, a person whose work involves manual labor would likely be more affected by muscle weakness or shortness of breath than is somebody who works in an office.”

Financial setbacks after these events may also take an emotional toll on patients and contribute to worse health outcomes, said Dr. Erica Spatz, an assistant professor of cardiovascular medicine at Yale School of Medicine in New Haven, Connecticut, who wasn’t involved in the study.

“More resources need to be made available to mitigate the financial toxicity associated with having a heart attack or stroke,” Spatz said by email. “One person’s financial toxicity or wage loss affects everyone – first and foremost the individual themselves and their dependents, but also our communities and healthcare system which ultimately shoulder the costs of worse health outcomes.”

SOURCE: CMAJ, online January 7, 2019.

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