Current Return-to-Work Outcomes and Barriers Among Patients With Cardiovascular Disease Undergoing Cardiac Rehabilitation　― A Questionnaire-Based Study ―

Abstract

Background: Many patients with cardiovascular disease show no obvious physical disability after hospital discharge, making it difficult to recognize functional decline and adapt appropriate accommodations. Therefore, this study examined return-to-work (RTW) outcomes and barriers after hospital discharge.

Methods and Results: We conducted a questionnaire among patients aged 18–64 years who underwent inpatient cardiac rehabilitation and were discharged between January 2018 and March 2023. Of 133 eligible patients, 54 responded (response rate 41%). Respondents were classified as: (1) returned to their original job; (2) returned to a different job; and (3) did not return to any job. The overall RTW rate was 96%, with 92% returning to their original job within 3 months. However, 81% of the respondents reported anxiety, mainly about physical strain and limited workplace understanding. Physicians were the most frequently consulted professionals, while other healthcare providers were rarely sought for advice.

Conclusions: Although most patients successfully returned to work, substantial anxiety persisted regarding workplace reintegration. A structured vocational support system is required, wherein healthcare providers proactively identify at-risk patients and deliver comprehensive guidance to support sustainable RTW outcomes.

According to the 2023 Basic Policy on Cardiovascular Disease (CVD) Control Promotion formulated by the Ministry of Health, Labour and Welfare of Japan, approximately 3.06 million individuals live with CVD, and of these, 19% are aged between 20 and 64 years.¹ Amid a shrinking and aging population, the workforce of Japan is projected to fall by 8.21 million between 2012 (62.70 million) and 2030.² Sustaining employment among workers with CVD is therefore essential to mitigate this decline.

As the workforce continues to age and lifestyle-related diseases become more prevalent, an increasing number of employees are living and working with CVD. Therefore, vocational support provided through cardiac rehabilitation is becoming more important. However, many patients with CVD appear physically healthy after hospital discharge, making it difficult for employers to recognize subtle declines in physical or mental capacity and provide appropriate accommodations.³

For working-age patients, maintaining employment while undergoing treatment is crucial for socioeconomic stability; however, few studies have systematically investigated the challenges encountered by these individuals during the return-to-work (RTW) process. To address this gap, we investigated not only the timing and patterns of RTW but also related concerns and support requirements among working-age patients with CVD who underwent cardiac rehabilitation at our hospital. This study aimed to analyze RTW outcomes after hospital discharge, identify key barriers, and develop effective strategies to facilitate successful workforce reintegration.

Methods

Participants in this study were patients admitted to the Department of Cardiology or Department of Cardiovascular Surgery at Shimane University Hospital who underwent cardiac rehabilitation and were discharged between January 1, 2018, and March 31, 2023. Eligible individuals were adults aged 18–64 years at the time of discharge who provided written informed consent. This age range was chosen because individuals aged ≥18 years can legally consent to research participation, and it aligns with aged classifications used in previous studies. This study included all employed individuals, encompassing full time, part time, and self-employed.

The exclusion criteria were as follows: (1) comorbidities unrelated to CVD (e.g., cerebrovascular disease, major orthopedic disorders, and developmental disabilities) that could hinder employment; (2) clear unemployment prior to admission (e.g., long-term unemployment or students); (3) inability to complete the questionnaire in Japanese; (4) death before discharge; and (5) incomplete clinical or employment data.

Eligible patients identified in our rehabilitation department database were mailed an explanatory letter, a questionnaire, and a stamped return envelope. Participants could either mail the completed questionnaire or complete the online survey via the provided QR code or URL (Google Forms). The questionnaire was distributed on April 1, 2024, ensuring that at least 1 year had elapsed since discharge, allowing sufficient time to assess RTW outcomes.

Respondents were classified into 3 groups: (1) Original-Job RTW, patients returned to the same position at the same workplace; (2) Different-Job RTW, patients returned to a different position or workplace; and (3) Unable-to-RTW, patients did not return to any form of employment.

The questionnaire included 8 items:

Question 1. Living with family members (yes/no).

Question 2. Income status of cohabiting family members.

Question 3. Occupational category before admission.

Question 4. Employment status before admission and at the time of the survey.

Question 5. Time from discharge to RTW, if applicable.

Question 6. Concerns about RTW (yes/no); if yes, specify the main concerns.

Question 7. Sources of advice regarding RTW.

Question 8. Hospital or workplace support that was – or would have been – helpful for RTW (open-ended question).

Questions 1–7 consisted of multiple-choice items, while Question 8 allowed free-text responses.

Participants first stated whether they lived with family members, and, if so, whether those family members earned an income (Questions 1 and 2). For occupational category before admission (Question 3), respondents chose from 11 options based on the Japanese Standard Occupational Classification issued by the Ministry of Internal Affairs and Communications in 2009: (1) Managerial; (2) Professional/Technical; (3) Clerical; (4) Sales; (5) Service; (6) Security; (7) Agriculture/Forestry/Fisheries; (8) Production/Processing; (9) Transport/Machine Operation; (10) Construction/Mining; and (11) Carrying/Cleaning/Packaging.⁴ Employment status before admission (Question 4) was recorded as full time, part time/temporary/contract, self-employed, or other. Respondents who returned to work reported the duration from discharge to RTW (Question 5) by selecting 1 of the following time frames: ≤3 days, ≤1 week, ≤1 month, ≤3 months, ≤6 months, ≤1 year, or >1 year. Early RTW was defined as return within 3 months, consistent with previous studies. Participants who experienced anxiety about RTW (Question 6) selected their concerns from a list, which included possible disease exacerbation, physical strain at work, lack of workplace understanding, availability of sick leave, inconvenience to co-workers, financial worries (e.g., reduced salary or medical costs), and increased psychological stress, with these response options adapted from prior Japanese studies.⁵ For Question 7, participants selected from a predefined list of individuals from whom they sought advice about RTW, including physician, nurse, rehabilitation staff, medical social worker, occupational health physician, workplace supervisor or co-worker, family, friend, or no one. Free-text responses to Question 8 were first coded as ‘positive comments’, ‘negative comments’, or ‘other’ by a cardiologist, a certified heart failure nurse, and a physical therapist. Through subsequent discussion, each response was then assigned to 1 of 4 provisional categories: (1) workplace support for RTW; (2) healthcare support for RTW; (3) barriers to RTW; or (4) patient-requested support for RTW.

We extracted the following demographic and clinical variables from medical records: primary diagnosis, age at admission, sex, height, body weight at discharge, body mass index at discharge, B-type natriuretic peptide (BNP) level, left ventricular end-diastolic diameter (LVDd), left ventricular ejection fraction (LVEF), hemoglobin (Hb) level, estimated glomerular filtration rate (eGFR), hemodialysis status, cardiopulmonary exercise test (CPET) performance status, length of hospital stay, number of cardiac rehabilitation days, discharge Functional Independence Measure (FIM) score, and living arrangement. If a patient was hospitalized multiple times during the study period, data from the most recent admission involving cardiac rehabilitation were used.

Ethics Statement

This study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board of Shimane University Faculty of Medicine (20230922-1). Before participation, respondents received a document explaining the purpose of the study, its content, and data handling. Respondents provided written informed consent through a questionnaire.

Statistical Analysis

Descriptive statistics were used to summarize patients’ characteristics. Continuous variables were presented as means and standard deviations. Statistical analyses were performed using EZR, a graphical interface for R (version 4.1.3; R Foundation for Statistical Computing, Vienna, Austria) that incorporates functions for biostatistics.⁶

Results

During the study period, 212 patients underwent cardiac rehabilitation. Of these, 79 met at least 1 exclusion criterion, leaving 133 eligible participants, who were then mailed the questionnaire. The mean interval from discharge to questionnaire distribution was 1,295±495 days (minimum 369 days). We received responses from 54 participants, 5 questionnaires were undeliverable, and 74 individuals did not respond, resulting in a response rate of 41% (Figure 1). The baseline characteristics of the respondents are summarized in Table 1. The cohort included 42 men and 12 women, with a mean age of 54.7±8.3 years. The mean length of hospital stay was 22.7±20.6 days, and the mean number of inpatient cardiac rehabilitation days was 13.5±13.4 days. The mean discharge FIM score was 124.4±2.8. The most common reason for admission was heart failure (n=19). The mean clinical values were as follows: LVEF 47.1±14.9%; LVDd 37.7±10.8 mm; BNP 202.5±346.7 pg/mL; Hb 12.8±2.1 g/dL; and eGFR 67.9±24.8 mL/min/1.73 m². Two patients underwent maintenance hemodialysis. A total of 15 patients underwent CPET, and 18 patients underwent outpatient cardiac rehabilitation after discharge. Only 1 patient lived alone, and 42 (78%) reported having at least 1 other household income earner.

Figure 1.

Study outline. Different-Job RTW, returned to a different position or workplace; Original-Job RTW, returned to the same position at the same workplace; RTW, return to work; Unable-to-RTW, did not return to any form of employment.

Table 1.

Baseline Characteristics

	All (n=54)	Original Job RTW (n=43)	Different Job RTW (n=9)	Unable to RTW (n=2)
Age (years)	54.7±8.3	55.3±8.1	52.8±10.1	52.0±8.5
Sex, female (%)	12 (22)	10 (23)	2 (22)	0 (0)
Height (cm)	166.6±8.8	166.8±8.8	165.1±9.6	170.3±6.6
Body weight (kg)	66.0±3.8	65.6±13.5	66.9±11.2	69.0±4.7
BMI (kg/m2)	23.6±3.8	23.5±4.0	23.5±4.0	23.8±0.2
Primary disease/surgical procedure (%)
Heart Failure	19 (35)	13 (30)	4 (44)	2 (100)
PCI	14 (26)	12 (28)	2 (22)	0 (0)
CABG	10 (19)	9 (21)	1 (11)	0 (0)
Valvular surgery	7 (13)	5 (12)	2 (22)	0 (0)
Major vascular surgery	3 (6)	3 (7)	0 (0)	0 (0)
Other	1 (2)	1 (2)	0 (0)	0 (0)
Length of hospital stay (days)	22.7±20.6	23.0±22.5	22.7±11.9	16.5±0.7
Total days of rehabilitation (days)	13.5±13.4	13.4±14.5	15.2±7.9	7.0±1.4
FIM (score)	124.4±2.8	124.4±2.7	125.6±0.7	119.5±6.4
LVEF (%)	47.1±14.9	45.8±15.0	54.3±8.2	41.5±34.6
LVDd (mm)	49.9±8.2	50.0±8.6	48.3±4.2	53.5±16.3
BNP (pg/mL)	202.5±346.7	205.8±382.7	156.4±105.7	337.9±273.0
Hemoglobin (g/dL)	12.8±2.1	12.8±2.1	12.8±1.5	12.1±6.0
eGFR (mL/min/1.73 m2)	67.9±24.8	68.6±25.0	70.2±22.0	42.2±30.8
Hemodialysis (%)	2 (4)	2 (5)	0 (0)	0 (0)
CPET (%)	15 (28)	13 (30)	2 (22)	0 (0)
Outpatient rehabilitation (%)	18 (33)	13 (30)	4 (44)	1 (50)
Solitary life (%)	1 (2)	1 (2)	0 (0)	0 (0)
Income from other (%)	12 (22)	9 (21)	3 (33)	0 (0)

Unless indicated otherwise, data are presented as mean±SD, or n (%). BMI, body mass index; BNP, B-type natriuretic peptide; CABG, coronary artery bypass graft; CPET, cardiopulmonary exercise test; eGFR, estimated glomerular filtration rate; FIM, Functional Independence Measure; LVDd, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; PCI, percutaneous catheter intervention; RTW, return to work.

Questionnaire results are summarized in Tables 2–6 and Figure 2. Of the 54 respondents, 52 returned to work, yielding an overall RTW rate of 96%. In the Original-Job RTW group, 92% resumed work within 3 months, compared with 44% in the Different-Job RTW group (Figure 2A). A total of 44 (81%) respondents reported some degree of anxiety about RTW. In the Original-Job RTW group, 34 (79%) respondents reported experiencing anxiety, although most of them achieved early RTW (Figure 2B).

Table 2.

Occupational Category Before Admission

	All (n=54)	Original Job RTW (n=43)	Different Job RTW (n=9)	Unable to RTW (n=2)
Managerial	7 (13)	7 (16)	0 (0)	0 (0)
Professional/technical	24 (44)	18 (42)	4 (44)	2 (100)
Clerical	4 (7)	4 (9)	0 (0)	0 (0)
Sales	2 (4)	2 (5)	0 (0)	0 (0)
Service	6 (11)	4 (9)	2 (22)	0 (0)
Security	0 (0)	0 (0)	0 (0)	0 (0)
Agriculture/forestry/fisheries	3 (6)	2 (5)	1 (11)	0 (0)
Production/processing	5 (9)	4 (9)	1 (11)	0 (0)
Transport/machine operation	1 (2)	0 (0)	1 (11)	0 (0)
Construction/mining	0 (0)	0 (0)	0 (0)	0 (0)
Carrying/cleaning/packaging	2 (4)	2 (5)	0 (0)	0 (0)

Unless indicated otherwise, data are presented as n (%). RTW, return to work.

Table 3.

Employment Status Before Admission and at the Time of the Survey

	All (n=54)	Original Job RTW (n=43)	Different Job RTW (n=9)	Unable to RTW (n=2)
Full time	40 (74)	32 (74)	6 (67)	2 (100)
Part time/temporary/contract	7 (13)	5 (12)	2 (22)	0 (0)
Self-employed	6 (11)	5 (12)	1 (11)	0 (0)
Other†	1 (2)	1 (2)	0 (0)	0 (0)

^†Corporate representative. Unless indicated otherwise, data are presented as n (%). RTW, return to work.

Table 4.

Concerns Regarding Returning to Work

	All (n=54)	Original Job RTW (n=43)	Different Job RTW (n=9)	Unable to RTW (n=2)
Possible disease exacerbation	22 (41)	16 (37)	4 (44)	2 (100)
Physical strain at work	34 (63)	26 (60)	6 (67)	2 (100)
Lack of workplace understanding	11 (20)	8 (19)	3 (33)	0 (0)
Availability of sick leave	11 (20)	8 (19)	3 (33)	0 (0)
Inconvenience to co-workers	24 (44)	21 (49)	3 (33)	0 (0)
Financial worries (e.g., reduced salary or medical costs)	8 (15)	4 (9)	4 (44)	0 (0)
Increased psychological stress	11 (20)	7 (16)	3 (33)	1 (50)

Unless indicated otherwise, data are presented as n (%). RTW, return to work.

Table 5.

Sources of Advice Regarding Return to Work

	All (n=54)	Original Job RTW (n=43)	Different Job RTW (n=9)	Unable to RTW (n=2)
Physician	34 (63)	30 (70)	4 (44)	0 (0)
Nurse	11 (20)	9 (21)	2 (22)	0 (0)
Rehabilitation staff	15 (28)	12 (28)	3 (33)	0 (0)
Medical social worker	4 (7)	4 (9)	0 (0)	0 (0)
Occupational health physician	0 (0)	0 (0)	0 (0)	0 (0)
Workplace supervisor or co-worker	25 (46)	19 (44)	5 (55)	1 (50)
Family	29 (54)	23 (53)	5 (55)	1 (50)
Friend	4 (7)	3 (7)	1 (11)	0 (0)
No one	4 (7)	2 (5)	1 (11)	1 (50)

Unless indicated otherwise, data are presented as n (%). RTW, return to work.

Table 6.

Categorization of Responses to Question 8 and Key Points

Category	Frequency	Key points
Workplace support for RTW	42%	• Adjustment of workload and working hours (e.g., exemption from night shifts, reassignment to lighter duties)
		• Maintenance of salary during the transition period
		• Understanding and encouragement from supervisors and co-workers
Healthcare support for RTW	13%	• Clear, personalized advice and thorough explanations of the patient’s condition from the attending physician
		• Structured rehabilitation guidance
		• Systematic follow up after discharge
Barriers to RTW	32%	• Inadequate workload or schedule adjustments (e.g., insufficient health considerations, inflexible work patterns)
		• Lack of opportunities to consult with employers
		• Insufficient communication of the patient’s medical condition to the workplace
Patient-requested support for RTW	13%	• Flexible working arrangements
		• Clear information on re-employment options and light-duty positions suited to their physical capacity
		• Practical strategies for balancing outpatient appointments with workplace responsibilities

RTW, return to work.

Figure 2.

(A) Time from discharge to return to work (RTW) for those returning to work (Question 5). (B) Anxiety about returning to work by group (Question 6). Different-Job RTW, returned to a different position or workplace; Original-Job RTW, returned to the same position at the same workplace; Unable-to-RTW, did not return to any form of employment.

Professional/technical occupations accounted for 44% of the cohort; notably, all participants in the Unable-to-RTW group belonged to this category. Managerial roles represented 13% of respondents, all of whom successfully returned to work. Although only a few respondents were engaged in physically demanding jobs, none were classified in the Unable-to-RTW group (Table 2).

Full-time employees constituted 74% of the cohort, and 73% of respondents who returned to work were full-time employees. However, both individuals in the Unable-to-RTW group were also full-time employees. Most part-time and self-employed respondents returned to their original workplaces (Table 3).

The most frequently cited concern regarding RTW was ‘physical burden at work’ (63%), followed by ‘inconvenience to co-workers’ (44%), and ‘possible worsening of illness’ (41%). The 2 patients in the Unable-to-RTW group selected ‘Possible disease exacerbation’, ‘Physical strain at work’, and ‘Increased psychological stress’ as their main concerns (Table 4).

Physicians were the most common source of advice (63%), followed by family (54%), and workplace supervisors or co-workers (46%). One of the 2 respondents in the Unable-to-RTW group did not seek advice from any source (Table 5).

Of the free-text responses to Question 8, 42% were concerned about workplace support for RTW, which was the most common theme, whereas 32% described barriers to RTW. Key points are summarized in Table 6, and the original comments are provided in the Supplementary Table.

Discussion

In the present study, 52 of 54 respondents returned to work, yielding an overall RTW rate of 96%, with the majority resuming work within 3 months of hospital discharge. Previous Japanese studies, primarily involving patients with myocardial infarction, have documented RTW rates of 74–83% among individuals with CVD.⁷ Internationally, RTW rates of 67–93% have been reported within 12 months after acute coronary syndrome treatment, with a mean RTW interval of 2–3 months.⁸ One study found that 64% of patients who completed cardiac rehabilitation returned to work within 6 months after surgery.⁹ Although direct international comparisons are limited by sociocultural and political differences, our results appear relatively favorable.

Among patients with CVD, several medical factors can impede RTW, including reduced LVEF, New York Heart Association functional class III or IV heart failure, and history of myocardial infarction, arrhythmias, and diabetes.^8,10,11 In our cohort, the 2 respondents who were unable to RTW exhibited poorer cardiac function, as indicated by higher BNP levels and lower LVEF, and diminished physical capacity, as indicated by lower FIM scores and reduced eGFR, than those exhibited by respondents who were able to RTW. These findings suggest that advanced heart failure and impaired functional status may hinder successful RTW.

CPET parameters have recently gained attention as potential predictors of RTW. A ventilatory equivalent for carbon dioxide slope >35 has been linked to a 15% reduction in the likelihood of RTW.¹² In 1978, the World Health Organization classified occupational intensity by the percentage of the estimated maximal oxygen uptake (V̇O₂ max): light work, <25% V̇O₂ max; moderate work, 25–50% V̇O₂ max; and heavy or very heavy work, >50% V̇O₂ max.¹³ An Italian study suggested that an oxygen-consumption level corresponding to 35–40% V̇O₂ max, as measured using CPET, permits continuous activity for 6–8 h.¹⁴ Similarly, the Japanese Circulation Society recommends CPET-based assessments of exercise tolerance, emphasizing their value in quantifying safety and workload at the time of RTW.^3,15 Responses to Question 8 indicated that physicians’ explanations of the rehabilitation plan and RTW were helpful, illustrating the value of individualized guidance derived from CPET results. However, only 28% of the respondents in the present study underwent CPET, and neither of the 2 individuals who were unable to RTW had undergone CPET. These findings suggest that CPET-based evaluations may influence RTW outcomes and could be useful for patients with more severe conditions.

RTW predictors extend beyond medical status and encompass a broad range of demographic and contextual variables, including age, sex, educational attainment, job-specific physical demands (occupational requirement profile), financial resources, psychosocial factors such as depression or cognitive impairment, regional labor market characteristics, employment type, and overall economic conditions.⁸ Pre-admission occupation is particularly informative when designing RTW interventions. Regarding employment categories among patients with CVD, our cohort contained a higher proportion of professional and technical workers, whereas previous studies reported a greater prevalence of managerial positions.⁷ In our cohort, patients in professional or technical roles had greater difficulty returning to work, whereas those in managerial positions had a comparatively higher RTW rate. These occupational distinctions should be considered when formulating tailored RTW interventions and workplace accommodations.

Employment type has also emerged as a significant social determinant of RTW. While regular employment seems to facilitate work resumption to some extent, some regularly employed individuals still failed to RTW. In contrast, several non-regular or self-employed respondents returned more easily, suggesting that these work arrangements may offer greater flexibility in accommodating changes to an employee’s health status. Overall, our findings indicate that RTW success depends not on employment type alone but on a complex interplay between the workplace environment, job demands, and individual health. The requests identified in the present study, including exemption from night shifts, reduced working hours, and other flexible work arrangements, align with the measures set out in the Ministry of Health, Labour and Welfare Guidelines for Supporting a Balance between Treatment and Work in the Workplace. Implementing these accommodations and engaging work-life balance support coordinators could therefore play a key role in assisting employees with CVD.¹⁶

Studies on RTW after coronary artery bypass grafting indicate that even medically stable patients without complications often experience anxiety, loss of self-confidence, and fatigue upon resuming work.^11,17 Our findings align with these observations, as both respondents who returned to work and those who did not reported experiencing some degree of anxiety, most commonly related to their physical ability to meet job demands. Therefore, effective RTW support must address not only medical factors but also psychological challenges, including fear of symptom recurrence and the physical burden of work. Persistent psychological stress and workplace reservations highlight the need for mental health services and broader organizational support. For individuals returning to work at different workplaces, systems that mitigate economic concerns, such as sickness benefits and counseling services, are essential. Several free-text comments to Question 8 highlighted psychological stress and insufficient workplace understanding. These issues fit within the risk-assessment and follow-up domains of the Japanese stress-check system, suggesting that applying this framework could benefit employees with CVD.¹⁸

Participation in cardiac rehabilitation is associated with a significantly higher RTW rate than that observed in control groups, regardless of age, sex, or occupation.^11,19 Emotional factors also influence RTW, highlighting the need for prompt identification and targeted psychosocial support.^11,20 In the present study, gaps in both information provision and RTW support were observed. Non-physician healthcare providers, particularly nurses and rehabilitation therapists, should adopt a more proactive role in vocational support, and institutions must ensure that patients are informed of available consultation resources.

Close collaboration between healthcare providers and employers is critical to facilitate RTW.²¹ However, external barriers, such as overestimation of health risks and inadequate workplace preparation, can impede successful reintegration. Therefore, identifying these obstacles is essential for designing effective support measures, including rehabilitation programs, psychosocial interventions, and educational initiatives. Workforce withdrawal imposes an economic burden not only on patients but also on society, leading to increased healthcare costs and reliance on public assistance (e.g., disability pensions and welfare), and decreased mental health and quality of life.²² The strategies identified in this study, including opportunities for workplace consultations, re-employment opportunities, and support measures that enable a balance between treatment and work, are consistent with the ‘strengthened collaboration among healthcare, industry, and government’ outlined in the Basic Plan for Cardiovascular Disease Countermeasures.¹ Coordinated efforts among healthcare providers, government agencies, and private enterprises are essential to promote workplace accommodations, implement phased RTW programs, and create multidisciplinary support frameworks. For example, occupational health nurses have reported that online consultations with managers and seminars for workers improved awareness and attitudes toward treatment–work balance support.²³ These initiatives should also raise awareness of RTW support services, expand employment-counselling resources for patients with CVD, and institute workplace policies that foster sustainable employment.²⁴

Few Japanese studies have examined long-term employment outcomes following hospitalization for CVD. Extended follow ups are needed, even at our institution, to assess sustained employment. The small sample size and limited generalizability inherent in single-center studies underscore the need for large multicenter investigations. Expanding research across diverse geographic regions would provide a more accurate representation of real-world RTW conditions, helping to shape more effective policies and practices.

Study Limitations

This study has several limitations. First, it was a single-center survey with a response rate of only 41%; hence, patients less interested in vocational support may be underrepresented. Second, the number of participants who did not RTW was small compared with that in previous reports, limiting the robustness of the subgroup analyses. Third, CPET was not performed in all patients. The primary reason appears to be the limited capacity and personnel for CPET at our hospital, which hindered its broader implementation. Fourth, the heterogeneity in underlying diagnoses and disease severity among respondents may have influenced our findings. Last, we did not use established instruments to evaluate RTW. Although no universal standard exists for patients with CVD, the Return-to-Work Self-Efficacy Scale has been widely used.^25,26 Incorporating additional measures for pain, fatigue, depressive symptoms, quality of life, and social support may have yielded more detailed information on the assistance required for successful RTW.²⁷ Further studies addressing these limitations are necessary to validate our findings.

Conclusions

We conducted a questionnaire survey for working-age patients with CVD who underwent cardiac rehabilitation at our hospital to evaluate their RTW outcomes and vocational support needs after hospital discharge. The overall RTW rate was 96%, and most respondents resumed their previous work within 3 months. However, many patients experienced anxiety related to RTW and few sought advice from healthcare professionals other than physicians. These findings highlight the need for a structured, multidisciplinary support system that enables healthcare providers to identify patients who require vocational support and deliver timely and comprehensive guidance.

Acknowledgments

This study was conducted with the support of the Shimane University Hospital Foundation for the Promotion of Advanced Medical Care (A7A00609). We thank Honyaku Center Inc. for English language editing.

IRB Information

This study adhered to the Declaration of Helsinki and the ethical standards of the responsible committee on human experimentation, and was approved by the Institutional Review Board of Shimane University Faculty of Medicine (20230922-1).

Data Availability

The deidentified participant data will not be shared.

Supplementary Files

Please find supplementary file(s);

https://doi.org/10.1253/circrep.CR-25-0033

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