Open Access

ARTICLE

Employment after heart transplantation among adults with congenital heart disease

by

1 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
2 Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA
3 Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
4 Section of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA
5 Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
6 Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
7 Department of Cardiothoracic Surgery, Nationwide Children’s Hospital, Columbus, Ohio, USA

* Corresponding Author: Dmitry Tumin, Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA. Email:

Congenital Heart Disease 2017, 12(6), 794-799. https://doi.org/10.1111/chd.12513

Abstract

Objective: Adults with congenital heart disease may require heart transplantation for end-stage heart failure. Whereas heart transplantation potentially allows adults with congenital heart disease to resume their usual activities, employment outcomes in this population are unknown. Therefore, we investigated the prevalence and predictors of work participation after heart transplantation for congenital heart disease.
Design: Retrospective review of a prospective registry.
Setting: United Network for Organ Sharing registry of transplant recipients in the United States.
Patients: Adult recipients of first-time heart transplantation with a primary diagnosis of congenital heart disease, performed between 2004 and 2015.
Interventions: None.
Outcome measures: Employment status reported by transplant centers at required follow-up intervals up to 5 y posttransplant.
Results: Among 470 patients included in the analysis (mean follow-up: 5 ± 3 y), 127 (27%) worked after transplant, 69 (15%) died before beginning or returning to work, and 274 (58%) survived until censoring, but did not participate in paid work. Multivariable competing-risks regression analysis examined characteristics associated with posttransplant employment, accounting for mortality as a competing outcome. In descriptive and multivariable analysis, pretransplant work participation was associated with a greater likelihood of posttransplant employment, while the use of Medicaid insurance at the time of transplant was associated with a significantly lower likelihood of working after transplant (subhazard ratio compared to private insurance: 0.55; 95% confidence interval: 0.32, 0.95; P = .032).
Conclusions: Employment was rare after heart transplantation for congenital heart disease, and was significantly less common than in the broader population of adults with congenital heart disease. Differences in return to work were primarily related to pretransplant employment and the use of public insurance, rather than clinical characteristics.

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