Who returns to work after a coronary heart disease event? Results from the EUROASPIRE IV study

Background Coronary heart disease (CHD) can lead to loss of workability and early retirement. The aim of this study is to investigate return to work (RTW) and its associations in patients with stable CHD based on data from the EUROASPIRE IV survey (European Action on Secondary and Primary prevention through Intervention to Reduce Events). Methods EUROASPIRE IV is a cross-sectional study carried out in 24 European countries in 2012-2013 through self-administered questionnaires, structured interviews and biophysical measurements. Patients participated in the survey 6 months to 3 years after the recruiting event (CABG, PCI, infarction). Sociodemographics, discharge- and self-reported medical history were analysed. To evaluate mental distress, health-related quality of life and physical capacity, the ‘Hospital Anxiety and Depression Scale’ (HADS), ‘HeartQoL’ and the ‘International Physical Activity Questionnaire’ (IPAQ ) were applied. Results Out of the 3278 employed participants, the majority (71.4%) returned to work with a small increase in part time employment (12.6 versus 7.3%). The two main reasons for non-RTW were age (52.9%) and heart disease (35.3%). Patients in the RTW-group (2339) were significantly younger, more highly educated (33.3 vs 21.0 %), predominantly treated with PCI (63.0 versus 57.6 %) and were more physically active (high IPAQ: 49.9 versus 42.0 %). The employed group displayed lower median scores on the HADS questionnaire (anxiety: 4.0 versus 5.0; depression: 3.0 versus 5.0) and higher scores on the HeartQoL instrument (2.37 versus 2.29). Through a logistic model significant higher odds for RTW were found in younger patients, higher education, PCI, lower depression and higher HeartQoL scores. Conclusions After undergoing a CHD event only three out of ten patients failed to return to the workforce, displaying worse sociodemographics (age, education) and more invasive treatment. Attention towards health promotion, improved quality of life and focus on mental factors (anxiety, depression, motivation) could help facilitate and sustain RTW

Long-term evolution of the mineral metabolism after renal transplantation : a prospective, single-center cohort study

Background. Abnormalities in bone and mineral metabolism are common after renal transplantation (RT) but information on their long-term time course is scarce. Objectives. (1) Evaluate the time course of biochemical parameters of bone and mineral metabolism over 60 months after RT; (2) identify predictors for persistent hyperparathyroidism (HPT). Design. Prospective, longitudinal, single-center cohort study. Methods. We determined serum levels (mean values +/- standard deviations) of intact parathyroid hormone (iPTH), calcium (Ca), phosphorus (P), magnesium (Mg), alkaline phosphatase (APh), calcitriol, and creatinine (Cr) preoperatively as well as 6, 12, 24, 36, 48, and 60 months after cadaveric RT in 49 patients. We in addition recorded demographic, clinical, and therapeutic data. Results. Pretransplantation iPTH stabilized from 194.2 +/- 273.5 to 71.5 +/- 50.7 ng/L at 6 months. Serum Ca (9.5 +/- 1.1 mg/dL) and APh (81.9 +/- 42.1 U/L) did not change. Baseline serum P (5.7 +/- 1.8 mg/dL) and serum Mg (2.4 +/- 0.4 mg/dL) decreased to normal ranges from month 6 onward. Low baseline calcitriol (22.4 +/- 21.8 pmol/L) normalized slowly by 12 months (95.4 +/- 46.7 pmol/L). Stable graft function (53.2 +/- 15.8 mL/min) was achieved from 6 months onward. By 60 months, 26.5% of patients had a serum Ca above 9.8 mg/dL and serum P below 2.7 mg/dL; 22.4%, an Mg below 1.7 mg/dL and 8.2%, a serum iPTH more than 2.5-fold the upper limit of normal. Upon multiple regression analyses the iPTH at 60 months was influenced by a dialysis duration >= 2 years (beta = 0.259, P = .003), body mass index > 25 kg/m(2) (beta = 0.257, P = .006), baseline iPTH (beta = 0.182, P = .036), serum Cr (beta = 0.268, P = .002) and Mg (beta = -0.242, P = .006). Conclusions. Hypercalcemia, hypophosphatemia, hypomagnesemia, and elevated iPTH persist in a subset of post-RT patients. Pretransplantation iPTH and obesity, dialysis duration, and posttransplant serum creatininemia and hypomagnesemia independently contribute to persistent HPT