1. Latil F, Iliou MC*, Boileau C, Pietri JX, Lechien C, Ha-vin P,** Simon M, Montourcy D, Guimond C. Service médical RSI d’Ile de France. * Hopital Corentin Celton APHP Issy les moulineaux ** SM RSI Marseille Return to work after an Acute Coronary Syndrome

2. Comparison of time to return to work (RTW) with a guide-line ( Health National Authority) Check the factors influencing RTW Survey on the uptake by the patients of the information they received Aims of the study

3. Eligibility criteria Self- employed workers (craftmen & shopkeepers) ; Paris & suburbs Prospectively recruited /one year period One year follow -up First ACS, ST+ or ST- (STEMI), proved by coronarography detection through sick-leave certificate

4. exclusion criteria Prévious coronary heart disease Stroke at the time; mentally impared Non french speaking patients Associated crippling disease (cardiac or not)

5. 229 ACS assessed for eligibility 13 Excluded: did not meet inclusion criteria 216 Included for follow-up 75 Examined 93 Called for medical examination 64 Returned to work29 No return to work (Disability or time out) 123 Returned to work 18 Not examined 90 days 365 days Flow chart of inclusion and participants’ RTW

6. Number of sick leave days according to workload 86 82 99 154 42 56 70 90 50 100 150 200 Low medium Hard Very hard Observed in practice According to the guide lines

7. Examined patients: healing may differ… Disabled group Waiting group N= 40 30 METs < required level 33 0 Hospital events 10 0 Comorbidities 13 0 LVEF<40% 10 0 Absence of RTW statement 13 Lenght of sick leave 169±84226±140 *

8. RESULTS 1°Main outcome duration of sick leave, was 93.3±103.7 days (95%CI: 78.6, 108.0), Median 61.5 Unchanged for the 20 last years +++ 55.2±53,6 days [Worcester 2014] No correlations between time RTW & clinical conditions Farkas J.[2008] correlation P<0,001 with doctor advice

9. Capacity determined by the exercise tests Exercise capacity N= lenght of sick leave __________________________________________________________________ Group A: Patient’s capacity > patient’s occupation 49 169.6 [130.3;208.9] __________________________________________________________________ Group B Patient’s capacity = patient’s occupation 9 215.1 [118; 312.3] __________________________________________________________________ Group C Patient’s capacity < patient’s occupation 2 98.5 [42.6;154.4]

10. Secondary outcome : Patients with higher cardiac performance were more likely to return to work (P 8.6 returned to work.

12. Checking the information up-take 3 medical topics - angina pectoris features - life tratment - physical activity 3 occupational topics - conditions of work - advice for RTW - Folder about RTW

13. Information uptake of the patients No rehabilitation Rehabilitation p χ2 N= 26 32 Medical information 69% 72% NS Occupational Information 38% 65% <0,03

14. Interview results from examined patients about information topics and the origin of the information they received

15. Thirty-day mortality and readmission rates in France. Medical Information System Programme (PMSI) data based on short-stay admissions in Medicine, Surgery and Obstetrics (MCO)

16. LIMITATIONS In a parallel study 34% of patients did not présent any sick leave (12days ±15) Lenght of H. Stay decrease ++ Only 32% of the patients are referred for cardiac rehabilitation

17. What we should do… Immediate Therapeutic education strategy ( Rehabilitation Center or out-patients) Creation of a case manager from the hospital or the social health fund The cardiologist should provide the GP with an opinion on the patient’s cardiac performances

18. You ‘re perfectly fine! See you in 6 months… And about my job????

19. 6 months later…

20. Waiting for Godot… (S. Beckett) …Or for Cardio ? THANK YOU FOR CHOOSING THIS WORKSHOP