@Article{chd.12747,
AUTHOR = {Maayke A. Sluman, Silke Apers, Judith K. Sluiter, Karen Nieuwenhuijsen, Philip Moons, Koen Luyckx, Adrienne H. Kovacs, Corina Thomet, Werner Budts, Junko Enomoto, Hsiao‐Ling Yang, Jamie L. Jackson, Paul Khairy, Stephen C. Cook, Raghavan Subramanyan, Luis Alday, Katrine Eriksen, Mikael Dellborg, Malin Berghammer, Eva Mattsson, Andrew S. Mackie, Samuel Menahem, Maryanne Caruana, Kathy Gosney, Alexandra Soufi, Susan M. Fernandes, Kamila S. White, Edward Callus, Shelby Kutty, Berto J. Bouma, Barbara J.M. Mulder},
TITLE = {Education as important predictor for successful employment in adults with congenital heart disease worldwide},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {3},
PAGES = {362--371},
URL = {http://www.techscience.com/schd/v14n3/38792},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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.<br/>
<b>Methods:</b> 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.<br/>
<b>Results:</b> 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).<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12747}
}