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Symptoms of Angina Pectoris Increase the Probability of Disability Pension and Premature Exit From the Workforce Even in the Absence of Obstructive Coronary Artery Disease
Study Questions:
Is there a relationship between the findings at coronary arteriography (CAG obstructive vs. nonobstructive or normal) in patients with stable angina pectoris and disability pension (DP), and premature exit from the workforce (PEW)?
Methods:
A total of 4,303 patients with no prior cardiovascular disease having a first-time CAG in 1998–2009 for stable angina, and 2,772 reference individuals from the Copenhagen City Heart Study, all ages <65 years, were assessed for DP and PEW through registry linkage.
Results:
Five-year age-adjusted DP-free survival probabilities for reference individuals, patients with angiographically normal coronary arteries, angiographically diffuse nonobstructive coronary artery disease (CAD), one stenotic coronary vessel (one-vessel disease), two-vessel disease, and three-vessel disease, respectively, were 0.96, 0.88, 0.84, 0.82, 0.85, and 0.78 in women and 0.98, 0.90, 0.89, 0.89, 0.88, and 0.87 in men. Significant predictors of DP were older, angina symptoms, higher body mass index, diabetes, smoking, job status, nonmarital status in men, lower income, lower educational level, and comorbidity. Compared with the reference population, probabilities of DP and PEW were significantly increased in all patients with no gender difference (p > 0.2 for interaction). In pooled multivariable-adjusted analysis, patients referred to CAG for angina had a three-fold higher probability of DP and approximately 50% higher probability of PEW, with little difference based on angiographic results.
Conclusions:
Patients with angina symptoms and angiographically normal coronary arteries, diffuse nonobstructive CAD, or obstructive CAD at angiography have a three-fold increased probability of DP regardless of angiographic findings.
Perspective:
The societal cost implications of the findings are quite high. In this study, approximately 12% of women and men were on a DP at a median of 5.5 years, and 25% prematurely exited from the workforce at a median of 4.8 years. The results are totally dependent on the criteria for disability pension, which in Denmark includes: ‘You must be deemed permanently unable to work due to physical, psychological, or social reasons.’ How and who decides was not reported.
Keywords: Coronary Angiography, Denmark, Probability, Angioplasty
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