# Return to Work After a Cardiovascular Event: The Central Role of Cardiac Rehabilitation

## TL;DR

This paper explores how cardiac rehabilitation helps people return to work after heart events by combining physical, psychological, and vocational support.

## Contribution

The study introduces workload-matching rules using METs and CPET, and emphasizes multidisciplinary cardiac rehabilitation for sustainable return to work.

## Key findings

- Depression, anxiety, and self-efficacy are strong predictors of return to work after cardiovascular events.
- CPET-guided exercise and MET-based job matching ensure sufficient metabolic reserve for work.
- Cardiac rehabilitation improves exercise tolerance, psychosocial well-being, and vocational outcomes.

## Abstract

Background: Return to work (RTW) after acute coronary syndrome (ACS) or acute heart failure (HF) is a pivotal outcome reflecting functional recovery and quality of life (QoL). While survival after cardiac events has improved through reperfusion and guideline-directed pharmacotherapy, sustainable RTW depends on an integrated set of clinical, psychological, social, and occupational determinants. Objective: This study aimed to synthesize and expand the evidence on predictors of RTW, delineate practical workload-matching rules using METs and CPET, and position multidisciplinary cardiac rehabilitation (CR) as the bridge from clinical recovery to durable vocational reintegration. Key findings: Beyond left ventricular ejection fraction (LVEF), depression, anxiety, illness perceptions, and RTW self-efficacy are robust predictors of vocational outcomes. CPET-guided exercise prescriptions and MET-based job matching ensure adequate metabolic reserve; sustained task demand should remain at ≤35–40% of maximal capacity, with peak capacity ≥2× average job demand. CR (Class IA in the 2023 ESC ACS Guidelines) improves exercise tolerance, medication adherence, psychosocial well-being, and deployment of vocational support, including stepwise reintegration plans and ergonomic adaptations. Telerehabilitation extends monitoring and counseling into the workplace and maintains adherence after RTW. Conclusions: Comprehensive CR that integrates exercise training, psychosocial counseling, lifestyle modification, and vocational interventions offers the most effective pathway to stable RTW, improved QoL, and reduced socio-economic burden. Early identification of vulnerable subgroups and personalized, digitally supported follow-up are essential for long-term job retention.