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. 2025 Sep 5;104(36):e44318. doi: 10.1097/MD.0000000000044318

Predictors of job maintenance in young and middle-aged patients after percutaneous coronary intervention: A retrospective cohort study

Yajun Hua a, Ya Wang a, Fan Fan a, Ting Chen a, Wei Yan a, Xudan Huang a, Yimao Sang b,*
PMCID: PMC12419261  PMID: 40922329

Abstract

This study evaluates job maintenance status and predictors of young and middle-aged patients after percutaneous coronary intervention (PCI). A total of 221 young and middle-aged patients after PCI from November 1, 2023 to January 31, 2025 were selected. The job readiness of patients who have not returned to work and the job maintenance of patients who have returned to work were investigated. The survey tools included general information questionnaire, readiness for return-to-work scale (RRTW), social support rating scale, cardiac rehabilitation inventory and self-rating anxiety scale (SAS). At 3-month follow-up, 81% (n = 179) of patients returned to work, with 19% (n = 42) remaining unemployed. Among patients returning to work, including high-maintenance (n = 109), low-maintenance (n = 52) and invalid (n = 18). Multivariate analysis identified cardiac rehabilitation inventory (OR = 1.122, 95% CI 1.051–1.199, P = .001), SAS (OR = 0.912, 95% CI 0.863–0.962, P = .001), and number of chronic conditions (OR = 0.580, 95% CI 0.365–0.920, P = .021) as independent predictors of job maintenance after PCI. The AUC of receiver operating characteristic curve is 0.795 (95% CI 0.725–0.865, P <.001), with 77.1% sensitivity and 69.2% specificity. Hosmer–Lemeshow test showed that the model had a good fitting degree (χ²=7.077, P = .528). Job maintenance of patients after PCI may be predicted by their cardiac rehabilitation information needs, anxiety levels, and chronic disease burden. The integration of psychosocial and clinical parameters provides a novel framework for personalized interventions targeting modifiable barriers to work resumption.

Keywords: job maintenance, percutaneous coronary intervention, predictor

1. Introduction

Coronary heart disease poses a serious threat to human health. Its incidence is increasing year by year, showing a trend of younger age.[1] Percutaneous coronary intervention (PCI) is a kind of delivery balloon catheter or other related devices to relieve coronary artery stenosis or obstruction and rebuild coronary blood flow, which can effectively rebuild blood flow and control the progress of the disease.[2] It is the main method to treat coronary heart disease at present. Following PCI, patients experience seriously hindered from participating in various social activities and undertaking work tasks, which has a great impact on their quality of life and personal development.[3,4] At the same time, it also brings a heavy economic burden to families and society.

Work is conducive to personal economic stability and life independence. It can also enhance patients’ sense of identity, clarify their role orientation, and facilitate their social integration. Returning to work (RTW) is one of the measures for the disease to return to normal.[5] RTW after illness can reduce the economic burden of society, families and individuals. It also has good social and economic benefits. According to a research report, the RTW rate of patients after PCI does not increase with time, but shows a downward trend.[6] Previous studies have shown that for RTW patients, the low job maintenance is related to the lower probability of sustainable RTW and fewer days of job participation,[7] and the high job maintenance is related to high job participation.[8] It is helpful to help patients maintain job better to clarify the predictors of job maintenance. A previous study showed that patients with good mental state and strong willingness to RTW have high job maintenance.[9] Simultaneously, males have more advantages in achieving high job maintenance than female.[10]

Young and middle-aged people are the main group to create social wealth and a powerful pillar of family economy and spirit. The progressively younger age of coronary heart disease has led to an increased proportion of young and middle-aged patients,[11] with more attention and challenges in their job maintenance.[12] Despite the growing number of young and middle-aged patients undergoing PCI, there is still a lack of comprehensive research on their job maintenance. This study thus aims to explore the current RTW situation and the predictors of job maintenance of young and middle-aged patients after PCI. And provide reference for the construction of continuous job support scheme.

2. Materials and methods

2.1. Study design and settings

This is a retrospective study. From November 1, 2023 to January 31, 2025, young and middle-aged patients after PCI in the cardiovascular department of a tertiary hospital in Zhejiang Province were selected as the research objects. The study was approved by the Ethics Committee of Yangming Hospital affiliated to Ningbo University (be also called Yuyao People’s hospital) (2024-06-005). All participants informed and agreed to participate voluntarily.

2.2. Participants

Participants aged 18 to 59 years, meeting PCI indications, possessing normal verbal communication and understanding abilities, and voluntarily participating in this study by signing the informed consent form, were included. Participants with malignant tumors, respiratory failure, severe liver insufficiency, or other major diseases, as well as those who were unemployed prior to PCI, were excluded from the study.

2.3. Data collection and instruments

Through the electronic medical record system, the general information, drug use, number of comorbidities, relevant examinations and inspection data were collected. Through telephone follow-up, whether the patient returned to work, work status, social support and anxiety were collected at the third month after discharge.

Based on reviewing previous studies, the general information questionnaire was compiled by researchers themselves, including gender, age, BMI, education level, marital status, medical payment method, number of medications taken, count of chronic diseases, and whether they have resumed their jobs. The readiness for return-to-work scale (RRTW)[13] comprises 2 sections with 6 dimensions in total. The first part is intended to assess the readiness of patients who have not RTW, encompassing 4 dimensions: pre-contemplation (not intending to RTW), contemplation (considering RTW), preparation (making plans to RTW), action (RTW). If 2 dimensions had equal highest scores, the patient was categorized into the lower-stage category (e.g., pre-contemplation over contemplation). Questionnaires with equal top scores in 3 or more dimensions were excluded from analysis due to invalid response patterns. The second part is used to evaluate the job maintenance of patients who have RTW. Includes 2 dimensions: uncertain maintenance and active maintenance. Patients in the “uncertain maintenance” category were deemed low-maintenance, whereas those in the “active maintenance” category were considered high-maintenance. Questionnaires with equal mean scores across 2 maintenance dimensions were deemed invalid and excluded from analysis. Cronbach α coefficients of 2 dimensions in Chinese Scale are 0.753 and 0.827, respectively.[14]

The social support rating scale[15] is used to evaluate the degree of social support of patients. It was compiled by China scholar Shuiyuan Xiao in 1986. The cardiac rehabilitation inventory (CRI)[16] is used to measure the individualized cardiac rehabilitation information needs of patients with cardiovascular diseases. The total Cronbach α coefficient of the Chinese version is 0.816.[17] Self-rating Anxiety Scale (SAS)[18] is used to evaluate the degree of anxiety of patients.

2.4. Statistical analysis

SPSS 26.0 (Chicago) was used for data processing and analysis. The measurement data were described by‾x ± s, and the comparison between the 2 groups was made by group t test. Counting data is described by use case (%), and χ2 test is used for comparison between groups. Wilcoxon rank sum test was used to compare the grade data. Binary logistic regression analysis was used for multivariate analysis. P <.05 is statistically significant.

3. Results

A total of 221 patients after PCI were included in this study. After a 3-month follow-up, the study revealed that 81% of the patients had successfully RTW, while 19% had not yet achieved RTW. Among the patients who did not RTW, 2 were in pre-contemplation, 8 in contemplation, 28 in preparation, 0 in action, with 3 invalid. Among the returning patients, 109 belong to the high-maintenance, 52 cases belong to the low-maintenance, with 18 invalid.

161 patients after PCI were included in the analysis, including high- (n = 109) and low-maintenance (n = 52) groups. In the context of post-PCI patient management, while demographic factors (age, gender, BMI, education) and clinical parameters (cardiac function, stent count, biomarkers) did not significantly differ between groups, the high-maintenance cohort exhibited a lower prevalence of chronic conditions (P = .006) alongside a higher incidence of polypharmacy (P = .006). Psychosocially, this group demonstrated higher cardiac rehabilitation information need (CRI, P <.001) and lower anxiety (SAS, P <.001), with no differences in social support or occupation (Table 1).

Table 1.

Characteristics of patients after PCI between high-maintenance group and low-maintenance group.

Variable High-maintenance group (n = 109) Low-maintenance group (n = 52) P-value
Demographic factors
 Age (year) 48.16 ± 6.883 48.90 ± 7.176 .526
 Gender
  Male 103 (94.5%) 48 (92.3%) .591
  Female 6 (5.5%) 4 (7.7%)
 BMI (kg/m²)
  <18.5 1 (0.9%) 0 .764
  18.5–23.9 36 (33.0%) 14 (26.9%)
  24–27.9 49 (45.0%) 26 (50.0%)
  ≥28 23 (21.1%) 12 (23.1%)
 Marital status
  Married 104 (95.4%) 51 (98.1%) .482
  Unmarried 2 (1.8%) 1 (1.9%)
  Divorced 3 (2.8%) 0
Clinical factors
 Cardiac function (NYHA class)
  I 93 (85.3%) 43 (82.7%) .640
  II 13 (11.9%) 6 (11.5%)
  III 0 0
  IV 3 (2.8%) 3 (5.8%)
 Number of stents 1.29 ± 0.532 1.33 ± 0.617 .725
 Number of chronic conditions 1.71 ± 0.831 2.10 ± 0.823 .006
 Number of lesion sites 1.83 ± 0.803 1.87 ± 0.841 .773
 cTn I (μg/L) 0.66 (0.04–2.36) 0.88 (0.05–3.21) .876
 BNP (pg/mL) 64.00 (18.00–155.00) 51.00 (20.25–141.50) .601
 LVEF (%) 61.58 ± 8.478 61.73 ± 7.693 .916
 Polypharmacy 82 (75.2%) 28 (53.8%) .006
Psychosocial factors
 Education level
  Primary school 40 (36.7%) 20 (38.5%) .951
  Middle school 46 (42.2%) 23 (44.2%)
  High school/technical 14 (12.8%) 5 (9.6%)
  Junior college 3 (2.8%) 2 (3.8%)
  Bachelor+ 6 (5.5%) 2 (3.8%)
 Living conditions
  Alone 7 (6.4%) 0 .163
  With spouse 98 (89.9%) 49 (94.2%)
  With children 3 (2.8%) 1 (1.9%)
  Other 1 (0.9%) 2 (3.8%)
 Healthcare payment
  Self-pay 17 (15.6%) 6 (11.5%) .491
  Insurance 92 (84.4%) 46 (88.5%)
 Occupation type
  Mental labor 12 (11.0%) 6 (11.5%) .921
  Physical labor 97 (89.0%) 46 (88.5%)
 CRI 45.83 ± 6.112 41.10 ± 5.955 <.001
 SAS 34.71 ± 6.071 39.81 ± 7.921 <.001
 SSRS 41.95 ± 5.336 41.38 ± 7.077 .571
Open in a new tab

BMI = body mass index, BNP = B-type natriuretic peptide, CRI = cardiac rehabilitation inventory, LVEF = left ventricular ejection fraction, NYHA = New York heart association, SAS = self-rating anxiety scale, SSRS = social support rating scale.

Multivariate logistic regression analysis revealed that CRI scores (OR = 1.122, 95% CI 1.051–1.199, P = .001), SAS scores (OR = 0.912, 95% CI 0.863–0.962, P = .001) and number of chronic conditions (OR = 0.580, 95% CI 0.365–0.920, P = .021) were associated with job maintenance after PCI. Notably, polypharmacy did not reach statistical significance in the model (Table 2).

Table 2.

Multivariate Logistic regression analysis of job maintenance of patients after PCI.

Variable Beta SE OR 95% CI P-value
CRI 0.115 0.034 1.122 1.051–1.199 .001
SAS −0.093 0.028 0.912 0.863–0.962 .001
Polypharmacy 0.635 0.419 1.888 0.831–4.288 .129
Number of chronic conditions −0.545 0.236 0.580 0.365–0.920 .021
Open in a new tab

CI = confidence interval, CRI = cardiac rehabilitation inventory, OR = odds ratio, PCI = percutaneous coronary intervention, SAS = self-rating anxiety scale.

The receiver operating characteristic analysis showed significant predictive power with an AUC of 0.795 (95% CI: 0.725–0.865, P <.001), achieving 77.1% sensitivity and 69.2% specificity at the optimal cutoff (Fig. 1). The Hosmer–Lemeshow test confirmed good model calibration (χ²=7.077, P = .528 >.05).

Figure 1.

Figure 1.

Open in a new tab

Receiver operating characteristic curve of the multivariate predictive model for job maintenance.

4. Discussion

This study is the first to evaluate job maintenance among young and middle-aged patients post-PCI, building upon previous research that has identified factors such as psychological status, social support, and health education as key influences on their ability to RTW. In this study, 81% of young and middle-aged patients RTW after PCI 3 months after discharge. The rate of RTW is higher than previous research.[12,19] Patients who can’t RTW suffer mental health damage due to the pressure of life and psychology, and are prone to negative emotions such as anxiety and depression, which seriously affects the quality of life of patients.[20] For RTW patients, compared with patients in high-maintenance, patients in low-maintenance show more mental health damage, more dysfunction, more fear avoidance and more current pain,[13] and the high job maintenance related to high job participation.[8] A study showed that although some patients with myocardial infarction have RTW, their work experience after illness is not optimistic, and they are struggling to face the impact of the disease and higher health requirements due to work needs.[21] Therefore, it is essential to RTW, and it is even more challenging to maintain a job.

In our study, 161 RTW patients after PCI were included in the analysis, including 109 high-maintenance and 52 low-maintenance patients. Cardiac rehabilitation information needs, anxiety, and chronic disease burden may related to job maintenance.

Young and middle-aged patients with higher cardiac rehabilitation information needs after PCI are more likely to have high job maintenance (CRI, OR = 1.122, 95% CI 1.051–1.199, P = .001). Ghisi et al[22] increased the patients’ knowledge of cardiac rehabilitation through intervention measures, and the self-efficacy and self-management ability of patients have been improved, which can enable patients to better cope with the challenges brought by diseases and work.[23] Micklewright et al[16] proposed that patients’ cardiac rehabilitation information needs should be met to the greatest extent. At the early stage of disease development, patients’ cardiac rehabilitation information needs should be evaluated, and health education implementation plans should be formulated in combination with patients’ information needs. The satisfaction of patients’ cardiac rehabilitation information needs determines their attitude towards the disease, which in turn affects their work plan. A global cross-sectional survey on cardiac rehabilitation information needs shows that respondents believe that the nature of cardiac events, a healthy diet, the benefits of exercise, how to take cardiac drugs, how to deal with angina pectoris and when to seek medical help, how to control risk factors and cardiac rehabilitation are the most important.[24] At the same time, gender, low-income countries and high-income countries also have significant differences in cardiac rehabilitation information needs.[24] However, in the actual clinical work, the information provided by medical staff can not completely meet the expectations of patients.[25] Therefore, accurately evaluating the type and degree of patients’ cardiac rehabilitation information needs is the first step for medical personnel to intervene and support patients. Using CRI or other scales (such as the Information Needs in Cardiac Rehabilitation) to quickly screen patients’ cardiac rehabilitation information needs before discharge and give targeted support and intervention can better enhance patients’ job prognosis.

Anxiety is an independent risk factor for job maintenance of young and middle-aged patients after PCI (SAS, OR = 0.912, 95% CI 0.863–0.962, P = .001). In addition to cardiovascular factors, the job prognosis of patients is mainly determined by psychological cognition.[26] Previous studies[27–29] have shown that anxiety delays the ability of patients to RTW and integrate into society, delays the time of RTW, and reduces job participation. Following adverse cardiac events, the decline in cardiac systolic function, cardiac function is impaired, which leads to the decline of physical activity ability.[30–32] After RTW, the patients showed high mental stress. At the same time, patients are prone to obvious negative emotions after RTW due to high work stress, which leads to the decline of self-health management ability and job participation.[33] Therefore, it is suggested to use the concise anxiety measurement questionnaire to make early diagnosis of patients’ mental status risk. Through the early screening of anxiety, depression and other negative emotions, psychological intervention is carried out targeting high-risk patients with the aim of encouraging early RTW and enhancing their job maintenance capabilities.

The chronic disease burden impacts the job maintenance of young and middle-aged patients after PCI (number of chronic conditions, OR = 0.580, 95% CI 0.365–0.920, P = .021). Sun et al[34] found that patients with more complications are less likely to RTW 3 months after discharge. In addition, patients with hypertension, liver and kidney diseases may have a negative impact on their RTW.[21,35] Multimorbidity increase the risk of death, ICU admission, hospitalization time and 30-day readmission.[36] Complications reflect the complexity of the disease to a certain extent.[37,38] A more complicated disease requires more skills and knowledge in management, making it harder to balance work and disease management. On the other hand, when a variety of diseases are combined, patients’ physical fatigue will increase and they will not be competent for work.[39,40] The results of this study suggest that medical staff should pay attention to the complications of chronic diseases, actively treat them, assess the health needs of patients at an early stage, carry out targeted health education and improve their ability to cope with diseases.

In addition to medical, psychological and occupational factors, economic conditions, working environment, health and support within the social health care system also play an important role for patients.[41,42] Collectively, our findings provide information for patients’ work support plan. Targeted intervention is needed for high-risk groups (low demand for cardiac rehabilitation, anxiety and multiple chronic diseases).

5. Conclusion

Job maintenance of patients after PCI may be predicted by their cardiac rehabilitation information needs, anxiety levels, and chronic disease burden. We discussed our views on these factors and possible solutions. The integration of psychosocial and clinical parameters offers a novel framework for designing personalized interventions aimed at addressing modifiable barriers to work resumption.

6. Limitation

This study has some limitations. Primarily, the study is confined to a single center and features a limited sample size, potentially introducing selection bias. Employing convenient sampling, the study may restrict the generalizability of its survey findings. Being retrospective in nature, the study may contain certain deviations. The study lacks longitudinal follow-up evaluation regarding the changes in job maintenance. In the future, the influence of longitudinal prediction on job maintenance will be explored to minimize the risk of job interruption after young and middle-aged patients RTW after PCI.

Author contributions

Conceptualization: Yajun Hua, Ya Wang, Yimao Sang.

Data curation: Yajun Hua, Ya Wang, Fan Fan, Ting Chen, Wei Yan, Xudan Huang.

Methodology: Fan Fan.

Project administration: Ya Wang, Fan Fan.

Writing – original draft: Yajun Hua, Yimao Sang.

Writing – review & editing: Yajun Hua, Ya Wang, Yimao Sang.

Abbreviations:

CRI
cardiac rehabilitation inventory
PCI
percutaneous coronary intervention
ROC
receiver operating characteristic
RRTW
readiness for return-to-work scale
RTW
return-to-work
SAS
self-rating anxiety scale
SSRS
social support rating scale

Informed consent was obtained from all individual participants included in the study.

The study was approved by the Institutional Review Board of (Yangming Hospital affiliated to Ningbo University [Yuyao People’s Hospital]) (Approval No. 2024-06-005).

This work was supported by the Zhejiang Provincial Medical and Health Science and Technology Plan (2023KY1069) and the Hospital-level project of Yuyao People’s Hospital (2023YA02).

The authors have no conflicts of interest to disclose.

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Hua Y, Wang Y, Fan F, Chen T, Yan W, Huang X, Sang Y. Predictors of job maintenance in young and middle-aged patients after percutaneous coronary intervention: A retrospective cohort study. Medicine 2025;104:36(e44318).

YH, YW, and FF contributed to this article equally.

All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

Contributor Information

Yajun Hua, Email: 158913983@qq.com.

Ya Wang, Email: 870790231@qq.com.

Fan Fan, Email: 416924203@qq.com.

Ting Chen, Email: 925578093@qq.com.

Wei Yan, Email: 799011366@qq.com.

Xudan Huang, Email: 1014548552@qq.com.

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