Employment Following Heart Transplantation in Canada

Purpose Heart transplantation (HT) improves functional capacity and extends survival. The ISHLT reports that approximately 70% of HT patients can perform their daily activities with no limitation, however, overall employment rates are less than 40% up to 5-years post-HT. Factors related to post-HT unemployment can inform interventions. We describe rates and clinical associates of employment in adult HT recipients. Methods We conducted a cross-sectional survey of consenting consecutive patients transplanted between 2000 and 2019 at a single institution. In a structured telephone survey, we collected information regarding social factors and employment status. Clinical data was abstracted from electronic patient records. We performed multivariable logistic regression to determine factors associated with either part-time or full-time employment post-HT. Results Of 295 patients alive, 234 patients were contacted and 134 consented and were included. Mean age was 45±13 and 63% were male. Forty (30%) patients were employed within 1-year prior to HT and had median length of time off work of 4 months (IQR 2-7). A total of 57 (43%) patients were employed after HT and started working in a median time of 21 months (IQR 13-25); 28 were employed within 1-year post-HT and started working in a median time of 5 months (IQR 3-8). Of the 77 patients who did not work post-HT, 19 age-appropriate patients retired. In adjusted analysis, increasing age per year and pre-HT employment within 1-year were associated with employment post-HT (Table). Presence of post-secondary education, spousal income, or number of dependents was not associated with employment post-HT. Conclusion Majority of patients employed post-HT are employed within 1-year of HT suggesting the optimal window for interventions to improve post-HT employment should be early. Furthermore, other social determinants of employment unrelated to education or personal finances, such as psychiatric wellbeing and motivation to work, maybe important to help patients obtain employment post-HT.