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Education as important predictor for successful employment in adults with congenital heart disease worldwide

Maayke A. Sluman1,2, Silke Apers3,4, Judith K. Sluiter1,*, Karen Nieuwenhuijsen1, Philip Moons4,5, Koen Luyckx6,7, Adrienne H. Kovacs8,9, Corina Thomet10, Werner Budts11, Junko Enomoto12, Hsiao‐Ling Yang13, Jamie L. Jackson14, Paul Khairy15, Stephen C. Cook16, Raghavan Subramanyan17, Luis Alday18, Katrine Eriksen19, Mikael Dellborg20,21, Malin Berghammer5,22, Eva Mattsson23, Andrew S. Mackie24, Samuel Menahem25, Maryanne Caruana26, Kathy Gosney27, Alexandra Soufi28, Susan M. Fernandes29, Kamila S. White30, Edward Callus31, Shelby Kutty32, Berto J. Bouma33, Barbara J.M. Mulder33

1 Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
2 Department of Cardiology, Jeroen Bosch Hospital, ‘s Hertogenbosch, The Netherlands 3 Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
4 Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
5 Center for Person‐Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden
6 School Psychology and Development in Context, KU Leuven, University of Leuven, Leuven, Belgium
7 Department of Psychology, UNIBS, University of the Free State, Bloemfontein, South Africa
8 Department of Psychology, University Health Network, Toronto, Canada
9 The Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
10 Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
11 Congenital and Structural Cardiology, Department of Cardiovascular Sciences, University Hospitals of Leuven, KU Leuven, Leuven, Belgium
12 Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
13 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
14 Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio
15 Montreal Heart Institute, University of Montreal, Montreal, Canada
16 Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, Michigan
17 Frontier Lifeline Hospital, Dr. K. M. Cherian Heart Foundation, Chennai, India
18 Division of Cardiology, Hospital de Niños, Córdoba, Argentina
19 Department of Cardiology, Oslo University Hospital, Oslo, Norway
20 Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
21 Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
22 Department of Health Sciences, University West, Trollhättan, Sweden
23 Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
24 Department of Pediatric Cardiology, University of Alberta, Edmonton, Canada
25 Monash Medical Center, Melbourne, Australia
26 Department of Cardiology, Mater Dei Hospital, Msida, Malta
27 Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
28 Hospital Louis Pradel, Lyon, France
29 Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children’s Hospital and Stanford Health Care, Palo Alto, California
30 Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, Missouri
31 Clinical Psychology Service, IRCCS Policlinico San Donato Hospital, Milan, Italy
32 Adult Congenital Heart Disease Center, University of Nebraska Medical Center/Children’s Hospital & Medical Center, Omaha, Nebraska
33 Amsterdam UMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands

* Corresponding Author: Maayke Sluman, Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, The Netherlands. Email: email

Congenital Heart Disease 2019, 14(3), 362-371.


Background: Conflicting results have been reported regarding employment status and work ability in adults with congenital heart disease (CHD). Since this is an impor‐ tant determinant for quality of life, we assessed this in a large international adult CHD cohort.
Methods: Data from 4028 adults with CHD (53% women) from 15 different countries were collected by a uniform survey in the cross‐sectional APPROACH International Study. Predictors for employment and work limitations were studied using general linear mixed models.
Results: Median age was 32 years (IQR 25‐42) and 94% of patients had at least a high school degree. Overall employment rate was 69%, but varied substantially among countries. Higher education (OR 1.99‐3.69) and having a partner (OR 1.72) were asso‐ ciated with more employment; female sex (OR 0.66, worse NYHA functional class (OR 0.67‐0.13), and a history of congestive heart failure (OR 0.74) were associated with less employment. Limitations at work were reported in 34% and were associated with fe‐ male sex (OR 1.36), increasing age (OR 1.03 per year), more severe CHD (OR 1.31‐2.10), and a history of congestive heart failure (OR 1.57) or mental disorders (OR 2.26). Only a university degree was associated with fewer limitations at work (OR 0.62).
Conclusions: There are genuine differences in the impact of CHD on employment status in different countries. Although the majority of adult CHD patients are em‐ ployed, limitations at work are common. Education appears to be the main predictor for successful employment and should therefore be encouraged in patients with CHD.


Cite This Article

Sluman, M. A., Apers, S., Sluiter, J. K., Nieuwenhuijsen, K., Moons, P. et al. (2019). Education as important predictor for successful employment in adults with congenital heart disease worldwide. Congenital Heart Disease, 14(3), 362–371.

cc This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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