Heart Disease, Work Performance, Mental Health All Connected

That's one of the notable conclusions of a study by a team of University of Michigan researchers who believe that understanding effects of a heart attack means not just looking at length of life but quality of life as well.

"People who are convinced they aren't that sick are more likely to be at work and to perform well while they're there," said Steve Erickson, associate professor of clinical sciences at the U-M College of Pharmacy.

In a paper published in a recent Pharmacotherapy: Official Journal of the American College of Clinical Pharmacy, Erickson and his collaborators look at work-related outcomes of cardiovascular disease. The study examines whether heart disease prevents people from returning to work, and how well they believe they are able to perform on the job.

The study found that those who have other illnesses before having a heart episode are less likely to return to work. "The heart attack becomes the straw that broke the camel's back," Erickson said.

Survey participants who did not return to work had a median of three other illnesses, while those who did go back had a median of one other illness besides heart disease.

Work performance is a concern as a part of overall quality of life, Erickson said. Depression commonly occurs in people who have a heart attack, so if a patient gets emotional satisfaction from work and health problems get in the way of working, his or her emotional state could suffer even more.

In addition, people who are depressed are less likely to make necessary changes in their diet and exercise habits, and are less likely to follow their prescribed medications—leaving them more vulnerable to future heart problems, Erickson said.

Co-authors of the study were Christopher McBurney, who at the time was a U-M Pfizer pharmacoeconomics fellow at the U-M School of Public Health; Kim Eagle, Albion Walter Hewlett Professor of Internal Medicine and clinical director of cardiology; Eva Kline-Rogers, nurse practitioner of cardiology at the U-M Health System; Jeanna Cooper, health science research associate in cardiology; and Dean Smith, statistician with the cardiology department.

Eagle has studied the quality of patient care for heart disease and whether they are getting the appropriate prescriptions, including the so-called fab four: aspirin, medications to lower cholesterol, and medicines to help reduce the work load of the heart, as well as those to lower blood pressure (ACE inhibitors and beta-blockers).

Erickson said his work on quality of life builds on that foundation by examining how those drugs affect people's ability to go on with their lives, and whether they are likely to comply with the prescriptions.

Erickson specializes in quality of life as it relates to disease management and treatment. Among his projects:

• He examined work-related outcomes in adults with asthma, and found disease severity, race, income and health beliefs all contributed to patients' perceived work performance.

• He is studying depression after heart attack, and preliminary findings show that in many patients with symptoms of depression, it is undiagnosed and untreated.

• He is beginning a project looking at qualitative measures of taking prescribed medicines appropriately. Instead of asking a yes or no question about whether patients take medicines as directed, he will look at a continuum of how often patients might forget or choose not to take prescriptions properly.

• He is launching a longitudinal study of anxiety disorder, looking at quality of life associated.

Erickson would like to develop a quick quality-of-life questionnaire patients could fill out prior to seeing a health care provider. Information gathered would give time-crunched doctors and nurses an easy way to identify areas they should talk about, like depression or not taking needed medication.

"It's important to look at more than blood pressure and percent blockage," Erickson said. "It's important to look at overall functioning and mental health and quality of life."

If a doctor finds out that a patient is not taking heart drugs as prescribed, for example, that opens the door to talk about how important they are to health and survival, Erickson said.

"Eventually we would like to help measure these items like risk of depression or nonadherence that a physical exam just can't catch," he said.