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Lost Productivity From Heart Attack, Stroke Are Twice Direct Medical Costs, Study Finds


The results come as US professional societies are updating primary prevention guidelines in cardiology.

The real costs of a heart attack or stroke doubles when lost wages and other indirect costs are added to the healthcare tab, results of a new study show.

Findings of World Health Day, published in the European Journal of Preventive Cardiology, show that those who return to work are 25% less productive in their first year back.

While there has been progress in reducing death rates from cardiovascular events, heart disease still claimed 18 million lives worldwide in 2015, and morbidity with cardiovascular disease (CVD) is expected to increase because of an aging population, as well as rising obesity and rates of diabetes. Last month, the American College of Cardiology and the American Heart Association updated their primary prevention guidelines to emphasize a focus on social determinants of health, and for the first time included 2 new classes of type 2 diabetes (T2D) therapies in the guidelines: sodium glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists.

Heart patients lost 59 days of work in their first year after an event, and caregivers lost 11 days, which the researchers calculated cost an average of €13,953 (ranging from €6641 to €23,160, varying by country). Strokes had a lower average cost of €13,773, with an average of 56 lost work days for patients and 12 for caregivers. The range was a narrower, from €10,469 to €20,215.

Researchers studied 394 patients from 7 European countries; these included 196 had acute coronary syndrome (86% had heart attacks and 14% unstable chest pain), and 198 who had strokes—who returned to work 3 to 12 months after the event. The findings were based on patient questionnaires, which were completed when the participants visited a cardiologist, neurologist, or stroke physician. The value of the time lost was calculated based on each country’s labor costs in 2018. The average age of patients was 53 years.

The reasons for lost productivity were consistent across countries: 61% of the lost days came from the initial hospitalization and sick leave after the event; 23% to 29% were absences that occurred after the initial sick leave for medical appointments or shorter leave, and 9% to 16% came from not feeling able to work at full capacity while at work. Patients who had suffered previous events or who had established cardiovascular disease lost more time than those who experienced their first event.

Of the participants, 27% of heart patients and 20% of stroke patients were obese, while 40% of heart patients and 27% of stroke patients were current smokers.

Study author Professor Kornelia Kotseva, of Imperial College London, UK, said noted that this study captured patients with comparatively mild events, since they returned to work. “Some still had to change jobs or careers, or work less, and caregivers lost around 5% of work time,” she said in a statement. “Not included in our study are those with more severe events who quit work altogether and presumably need even more help from family and friends."

Of note, caregivers are also affected when a cardiovascular event occurs. "Productivity loss associated with cardiovascular events is substantial and goes beyond the patient," Kotseva said. "The true tragedy is that so many heart attacks and strokes could be averted by not smoking, being physically active, eating healthily, and controlling blood pressure and cholesterol. The evidence could not be stronger."

Employers are paying more and more attention to prevention as they seek ways to reduce lost productivity, including from heart attacks and strokes. While early efforts looked at rewarding healthy behavior, some employers are looking at penalties for unhealthy behavior in an effort to hold down healthcare costs.


Kotseya K, Gerlier L, Sidelnikov E, et al. Patient and caregiver productivity loss and indirect costs associated with cardiovascular events in Europe [published online April April 7, 2019]. Eur J Prev Cardiol. 2019; doi:10.1177/2047487319834770.

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