Many heart attack survivors return to work soon after recovery, but not all of them stay, a new study shows.

The findings, published Wednesday in Journal of the American Heart Association, show one in four survivors leave their job within a year after returning to work.

Earlier studies have looked at return to work following a heart attack, but this study analyzed long-term employment.

Among 22,394 heart attack sufferers from Denmark who were employed before having a heart attack, 91 percent returned to work within a year. However, 24 percent of those who returned to work left their jobs within a year and were supported by social benefits. The data did not include whether people left their jobs voluntarily.

“The ability to remain employed following a heart attack is essential to maintaining one’s quality of life, self-esteem, emotional and financial stability, so our findings carry critical implications not only for Danish patients but, perhaps more importantly, for people who live in countries with less advanced social welfare systems than Denmark,” said the study’s lead author Laerke Smedegaard, M.D., of Herlev & Gentofte University Hospital in Hellerup, Denmark.

The highest rate of work dropout was among 30- to 39-year-olds and 60- to 65-year-olds. The finding that younger people are more likely to leave employment is particularly alarming, researchers say, because this population has more productive work years left.

People with heart failure, depression or diabetes were far more likely to drop out of the workforce, the study showed. People with higher education and income were more likely to remain employed compared with those with lower educational and income levels.

After a heart attack, health care providers focus on preventing complications, such as recurrent heart attacks, heart failure and whether a patient returns to work.

“When evaluating a heart attack patient’s quality of life and functional capacity, simply returning to work after a heart attack isn’t enough. Our findings suggest that cardiac rehabilitation after a heart attack should also focus on helping people maintain their ability to work in the long-term for those who return to work,” Smedegaard said.

Denmark has a highly socialized health care system and one of the lowest inequality gaps in the world, according to the researchers.

“Despite these favorable conditions, we found that low socioeconomic status was associated with subsequent detachment from the workforce after patients had returned to work,” Smedegaard said. “Thus, our results are even more relevant to countries with larger inequality gaps.”

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