Understanding Bereavement

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Research · for Stroke & heart survivors' organisations

Working life after a stroke or cardiac arrest: most return, many do not stay

Published 2026-10-16

Most working-age adults who survive a stroke or a cardiac arrest go back to work, but a large share do not, and many who return leave again. The strongest data, from Denmark’s national registers, show that staying in work can be as hard as getting back, and that the factors linked to leaving include effects other people cannot see: fatigue, changes in thinking and memory, and low mood.

A stroke or a cardiac arrest in mid-life arrives without warning. One day someone is working, paying the rent and the bills, perhaps raising children or caring for a parent; the next they are in intensive care or a stroke unit. For those who survive, the questions that follow are practical as well as medical: whether they will go back to their job, manage a full day, or keep the household income steady. This study gathers the best published evidence, from any country, on what happens next, and where support falls short.

About 15%of all new strokes worldwide each year occur in people aged 15 to 49, according to modelled global estimates (GBD 2021) published by the World Stroke Organization in 2025[1]
56.6% vs 96.6%of working-age adults in Denmark were active in the labour market six months after an ischaemic stroke, compared with matched people in the general population (2005–18 register data)[2]
53.0%of Danish adults aged 18 to 60 who went back to work after an ischaemic stroke left the workforce again during five years of follow-up (1997–2017)[3]

Stroke is not only a disease of old age, and survival from cardiac arrest is still rare

The World Stroke Organization's 2025 fact sheet, built on modelled GBD 2021 estimates, puts the number of new strokes at almost 12 million a year worldwide, about 1,762,000 of them in people aged 15 to 49[1]. Some 20,319,000 people aged 15 to 49 are living after a stroke: 22% of all stroke survivors[1]. Over 34% of subarachnoid haemorrhages, bleeds on the surface of the brain, are in people aged 15 to 49[1].

A separate analysis of GBD data for 204 countries found that, although age-standardised rates generally fell between 1990 and 2021, the number of new strokes among 15 to 49-year-olds rose by 36% and the number of young adults living after a stroke by 41%; from 2015, the age-standardised incidence of ischaemic stroke and subarachnoid haemorrhage in this age group rose[4]. These are modelled estimates rather than counts, and are least certain where health records are weakest.

For cardiac arrest outside hospital the starting point is different: most people do not survive. A 2020 meta-analysis of 141 studies of adults who received cardiopulmonary resuscitation (CPR) found pooled survival to hospital discharge of 8.8%, and 7.7% at one year[5]. Evidence on working-age survivors comes mainly from a few countries with linked national registers. In Denmark, of 12,332 cardiac arrests in people aged 18 to 65 between 2001 and 2011, 4,354 were in people who had been in work, and 796 of them were alive 30 days later[6].

Most survivors return to work within a year, but many do not stay

In a Danish register study of everyone aged 18 to 60 who was active in the labour market when they had a first stroke between 2005 and 2018 (16,577 ischaemic strokes, 2,025 intracerebral haemorrhages and 4,305 subarachnoid haemorrhages), most went on sick leave within three weeks: 62%, 69% and 52% respectively[2]. Six months after an ischaemic stroke, 56.6% were active in the labour market, against 96.6% of matched people from the general population; at two years the figures were 63.9% and 91.6%[2]. Adjusting for socioeconomic and health differences between the groups changed these contrasts little. People with intracerebral haemorrhage were less likely to return than people with the other two types[2]. These were mostly mild strokes, in a highly resourced country.

A second Danish register study followed 28,325 people aged 18 to 60 who were in the workforce when they had a first ischaemic stroke between 1997 and 2017[3]. Within a year, 73.4% had returned to work, ranging from 87.0% of those aged 18 to 30 to 71.3% of those aged 51 to 60. But of those who went back, 53.0% left the workforce again over five years of follow-up[3]. Return was also more common among people with a long higher education (80.3%) than among those with basic (72.1%) or vocational (71.3%) education[3].

Elsewhere the evidence is thinner. A 2025 study of adults aged 18 to 50 with ischaemic stroke at two hospitals in Singapore found 68.8% had returned to work, and a meta-analysis in the same paper, of six cohort studies of young adults, put the pooled return-to-work figure at 63.2%[7]. A 2026 systematic review of 39 studies of working-age stroke survivors found reported return-to-work rates ranging from 7.5% to 100%[8], reflecting differing definitions, timings and health systems. Across 39 studies of people under 65, a 2024 meta-analysis found that men had higher odds of returning (odds ratio 1.26), as did people in white-collar jobs (1.84), while people with aphasia, a difficulty with language, had lower odds (0.37), as did people with a haemorrhagic stroke, a bleed in or around the brain (0.53)[9].

Of 22,394 Danes aged 30 to 65 who were in work before a first heart attack between 1997 and 2012, 91.1% had returned within a year, but one year after going back 24.2% were detached from employment and receiving social benefits, a higher rate than among matched population controls[10]. Where the heart attack caused cardiogenic shock, a collapse in the heart's pumping, 52% returned within a year, against 83% of those without it[11]. Among the 796 working-age Danes who survived 30 days after an out-of-hospital cardiac arrest, 610 (76.6%) returned to work, after a median of four months; 74.6% of those who returned stayed in work without sick leave for the next six months[6]. That proportion rose from 66.1% for arrests in 2001–2005 to 78.1% in 2006–2011, and bystander CPR was linked to a higher chance of sustained return (hazard ratio 1.38)[6]. After the most severe, refractory cardiac arrests, about one in two survivors who had been in work were employed a year later[12].

Returning to work after a sudden serious illness: previously employed working-age adults in DenmarkFour separate Danish national register studies. Returned to work within one year: first heart attack, ages 30-65, 1997-2012, 91.1%; first ischaemic stroke, ages 18-60, 1997-2017, 73.4%; heart attack with cardiogenic shock, ages 18-63, 2005-2015, 52%. Out-of-hospital cardiac arrest, 30-day survivors aged 18-65, 2001-2011: 76.6% returned to work during follow-up, median time 4 months.0%25%50%75%100%Heart attack (1997-2012),within 1 year91.1%Cardiac arrest survivors(2001-2011), during follow-up76.6%Ischaemic stroke(1997-2017), within 1 year73.4%Heart attack withcardiogenic shock (2005-2015), within 1 year52%
People who were in work before their illness and survived it. Four separate studies with different years, age ranges and definitions, so the bars are not directly comparable; the cardiac arrest figure is not limited to the first year. Returning is not the same as staying: 24.2% of heart attack survivors were detached from employment a year after going back, and 53.0% of stroke survivors who returned left the workforce again within five years. Sources: Smedegaard et al. 2017; Kragholm et al. 2015; Rosendahl et al. 2024; Lauridsen et al. 2022.

The effects nobody sees: fatigue, thinking and mood

A 2026 systematic review of 39 studies found that changes in cognition, the ability to concentrate, remember and process information, were the factor most commonly associated with return-to-work outcomes after stroke, ahead of stroke severity, mood and physical function, and that this held even after milder strokes[8]. Across the studies, the share of survivors with cognitive impairment ranged from 17.5% at 28 days to 89% at seven years, depending on how and when it was measured. The reviewers highlighted “the invisible nature of post-stroke cognitive impairment and limited awareness among employers and clinicians”[8].

Fatigue is common too. A 2021 meta-analysis of 35 studies (6,851 people) estimated that 48% of stroke survivors had clinically significant fatigue on the most widely used scale[13]. Depression after stroke is also frequent: an updated meta-analysis of 61 studies including 25,488 people put the pooled frequency at 31% at any time up to five years after stroke; estimates confined to one to five years (25%) and to five years (23%) were lower[14]. These pooled figures cover stroke survivors of all ages, not only those of working age, and the evidence specific to younger adults is much thinner.

Cardiac arrest survivors face similar effects. A 2023 meta-analysis of 32 studies found pooled anxiety of 24% in the short term and 22% in the long term among cardiac arrest survivors, rising to 28.0% in the short term for people whose arrest happened outside hospital; pooled depression was 19% in both the short and long term, and 18% and 17% respectively after out-of-hospital arrest[15]. In the Danish heart attack cohort, people with depression had 1.77 times the odds of becoming detached from employment after returning to work, a larger association than for heart failure or diabetes[10]. That is an association, not proof of cause.

Hidden effects: pooled estimates from meta-analyses of stroke and cardiac arrest survivorsClinically significant fatigue after stroke 48% (35 studies); depression after stroke 31% (61 studies); short-term anxiety after out-of-hospital cardiac arrest 28%; short-term depression after out-of-hospital cardiac arrest 18% (32 studies).0%20%40%60%Fatigue after stroke48%Depression after stroke31%Anxiety afterout-of-hospital cardiac arrest (short term)28%Depression afterout-of-hospital cardiac arrest (short term)18%
Pooled estimates from meta-analyses of studies in many countries, using different measures and timings; they cover survivors of all ages, not only working-age adults. Sources: Alghamdi et al. 2021 (fatigue); Hackett & Pickles 2014 (depression after stroke); Chen et al. 2023 (cardiac arrest).

Losing a job, a role or an expected future can bring a grief of its own, though these studies rarely measure it. Families of people who did not survive are bereaved suddenly; the evidence on bereavement and work covers their working lives.

Employment falls further than earnings, and the impact reaches partners

How much income people lose depends heavily on sick pay, disability benefits and employment protection where they live. Few studies measure it directly, almost all in high-income countries. In Denmark, receipt of a disability pension two years after an ischaemic stroke was 12.2% among working-age patients, against 0.6% of matched people, and sick leave and disability pension were the most common reasons people were not working[2]. In the United States, an analysis of Health and Retirement Study data, comparing stroke survivors with themselves before their stroke, found that a stroke immediately halved the probability of being employed, and the hours and weeks worked, one year later, with effects lasting at least three years; the fall in earnings was more moderate and gradual[16].

Working life after ischaemic stroke in Denmark, compared with matched people from the general populationAdults aged 18-60 active in the labour market at the time of a first ischaemic stroke, 2005-18, compared with matched individuals. Labour market participation at six months 56.6% vs 96.6%; at two years 63.9% vs 91.6%. Sick leave at six months 39.8% vs 2.6%. Disability pension at two years 12.2% vs 0.6%.After ischaemic strokeMatched population0%25%50%75%100%In the labour market at 6months56.6%96.6%In the labour market at 2years63.9%91.6%On sick leave at 6 months39.8%2.6%Receiving disabilitypension at 2 years12.2%0.6%
Danish Stroke Registry linked to national employment and benefit registers; 16,577 people with ischaemic stroke, mostly mild, and matched individuals from the general population. Adjusting for socioeconomic and health differences changed the contrasts little. Source: Skajaa et al., BMJ 2023.

A Swedish register study of spouses aged 60 or under whose partner had a stroke, compared with matched reference individuals, found the financial consequences for spouses overall were small; but younger women whose partner had a stroke saw their income from paid work fall by an average of €1,614, and the picture differed again for spouses of people left with severe disability[17]. The wider effect on families with children is covered in our study of families where a parent has a sudden serious illness.

In the Danish data, people with long higher education were more likely to return to work after stroke and far less likely to leave again: 13.0% left within a year of returning, against 28.4% of those with basic education[3]. After heart attack, high education and high income favoured staying in work[10], and white-collar workers had higher odds of returning after stroke[9]. These are associations, adjusted for some factors only, but they suggest that people with the fewest resources are also the least likely to keep their place in work.

Return-to-work support is recommended, but the evidence for it is thin

Research on what helps is sparse. A 2023 systematic review of interventions for working-age stroke survivors found only twelve studies, including three randomised trials, with employment at follow-up ranging from 7% to 75.6%; it concluded that there is “limited published high-quality evidence regarding the effectiveness of interventions to promote return to work in working-age survivors of stroke”[18]. A 2024 meta-analysis of 13 studies with 4,282 participants found that work-related interventions had little or no measurable effect on return-to-work rates, while physiological interventions were associated with a modest improvement (risk ratio 1.19)[19]. That does not mean support does not matter: the programmes tested so far have been small, varied, and rarely built around the fatigue, cognitive and emotional changes the observational research keeps identifying.

England's National Institute for Health and Care Excellence (NICE) stroke rehabilitation guideline, updated in 2023, asks services to “identify any return-to-work issues for the person as soon as possible after stroke” and to review and manage them actively, naming problems such as “fatigue preventing attendance for a full day at work, cognitive impairments”; it also recommends considering referral to a return-to-work programme for people who were working before their stroke[20]. The European Resuscitation Council and the European Society of Intensive Care Medicine's 2025 post-resuscitation guidelines include long-term outcome and rehabilitation within the care of cardiac arrest survivors[21].

What the evidence asks of us

  • Plan for staying in work, not only returning. The Danish registers show that a first return is often followed by a second exit[3][10]. Follow-up that continues after a return addresses the point where many people leave.
  • Look for the hidden effects. Cognitive change, fatigue and low mood are common and are linked to poorer work outcomes even after milder strokes[8][13]. Assessing them before and after a return, as NICE recommends for stroke[20], and raising awareness among employers, would help.
  • Treat mental health as part of recovery. Anxiety and depression affect a substantial minority of cardiac arrest and stroke survivors[14][15], and depression was linked to leaving work after heart attack[10].
  • Close the gap for people with fewer resources. Return and retention are lower for people with less education, lower incomes and jobs outside white-collar work[3][9][10]. Vocational support, and secure public sick pay and disability benefits, matter most to them.
  • Fund better trials and collect better data. Larger, well-designed trials of return-to-work support, built around fatigue, cognition and mood, are needed[19][18]. Outside a few Nordic countries, linked employment data barely exist, yet most of the world’s stroke deaths and disability fall in lower-income and lower-middle-income countries[1], where such data are rarest.

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer, and refers to “stroke survivors” and “people who have had a stroke or cardiac arrest”, the terms used by many survivors’ organisations. It does not describe illness as a battle.

Why we're publishing this

A sudden serious illness in working life changes jobs, incomes and plans, often after hospital care ends, when support is thinnest. The evidence gathered here shows that most working-age survivors do return to work, and that the barriers that push many out again, from fatigue and cognitive change to mood and inequality, are well documented. Much of it points to gaps in follow-up and support rather than to anything about survivors themselves. We offer it to the organisations that work alongside survivors and their families.

How to read this data

Most of the strongest evidence comes from Danish national registers, which link hospital, employment and benefit records for the whole population. These studies are large and not self-selected, but describe one high-income country with comparatively strong social security; findings may not transfer elsewhere. The four Danish return-to-work figures in the first chart come from separate studies with different years, age ranges and definitions, so they are not directly comparable. Global stroke figures are modelled GBD estimates, not counts. Pooled figures on depression, anxiety and fatigue come from meta-analyses of studies that used different measures and timings, and mostly cover survivors of all ages. Odds ratios and hazard ratios describe associations after adjustment for some factors, not all, and do not show cause. There is very little evidence on working-age survivors in low- and middle-income countries, on self-employed and informal workers, or on survivors’ own grief for the working lives they had.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, schools, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Suggested citation: Understanding Bereavement (2026). Working life after a stroke or cardiac arrest: most return, many do not stay. https://understandingbereavement.org/research/working-age-sudden-illness

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual person or family. If you are worried about your health or about someone close to you, please speak to a GP or another qualified professional.

Sources

  1. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. International Journal of Stroke, 2025. europepmc.org/article/PMC/PMC11786524
  2. Skajaa N, Adelborg K, Horváth-Puhó E, et al. Labour market participation and retirement after stroke in Denmark: registry based cohort study. BMJ, 2023. europepmc.org/article/PMC/PMC9809469
  3. Rosendahl E, Carlson N, Kragholm K, et al. Education and age in return to work after ischemic stroke: a Danish nationwide registry-based cohort study. The Neurologist, 2024. europepmc.org/article/MED/38872349
  4. Zhang M, Long Z, Liu P, et al. Global burden and risk factors of stroke in young adults, 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021. Journal of the American Heart Association, 2025. europepmc.org/article/MED/40371619
  5. Yan S, Gan Y, Jiang N, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Critical Care, 2020. europepmc.org/article/PMC/PMC7036236
  6. Kragholm K, Wissenberg M, Mortensen RN, et al. Return to work in out-of-hospital cardiac arrest survivors: a nationwide register-based follow-up study. Circulation, 2015. europepmc.org/article/MED/25941005
  7. Kwok GYR, Yeong N, Law M, et al. Return to work after ischemic stroke in young adults: a multicenter cohort study, systematic review, and meta-analysis. Journal of the American Heart Association, 2025. europepmc.org/article/MED/40178096
  8. Cunningham LJ, Stapleton T, Walsh K, Horgan F. Post-stroke cognitive impairment is associated with poorer return-to-work outcomes in working-aged stroke survivors: a systematic review. Clinical Rehabilitation, 2026. europepmc.org/article/MED/41666123
  9. Orange C, Lanhers C, Coll G, et al. Determinants of return to work after a stroke: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 2024. europepmc.org/article/MED/37797913
  10. Smedegaard L, Numé AK, Charlot M, et al. Return to work and risk of subsequent detachment from employment after myocardial infarction: insights from Danish nationwide registries. Journal of the American Heart Association, 2017. europepmc.org/article/PMC/PMC5721858
  11. Lauridsen MD, Rørth R, Butt JH, et al. Return to work after acute myocardial infarction with cardiogenic shock: a Danish nationwide cohort study. European Heart Journal: Acute Cardiovascular Care, 2022. europepmc.org/article/MED/35425972
  12. Gregers E, Kragholm K, Linde L, et al. Return to work after refractory out-of-hospital cardiac arrest in patients managed with or without extracorporeal cardiopulmonary resuscitation: a nationwide register-based study. Journal of the American Heart Association, 2024. europepmc.org/article/PMC/PMC11179786
  13. Alghamdi I, Ariti C, Williams A, et al. Prevalence of fatigue after stroke: a systematic review and meta-analysis. European Stroke Journal, 2021. europepmc.org/article/PMC/PMC8948505
  14. Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. International Journal of Stroke, 2014. europepmc.org/article/MED/25117911
  15. Chen X, Li D, He L, et al. The prevalence of anxiety and depression in cardiac arrest survivors: a systematic review and meta-analysis. General Hospital Psychiatry, 2023. europepmc.org/article/MED/37028095
  16. Tanaka A. The effects of sudden health reductions on labor market outcomes: evidence from incidence of stroke. Health Economics, 2021. europepmc.org/article/MED/33819359
  17. Labori F, Persson J, Svensson M, Bonander C. The impact of stroke on spousal and family income: a difference-in-difference study from Swedish national registries. Topics in Stroke Rehabilitation, 2024. europepmc.org/article/MED/37842918
  18. Pearce G, O'Donnell J, Pimentel R, et al. Interventions to facilitate return to work after stroke: a systematic review. International Journal of Environmental Research and Public Health, 2023. europepmc.org/article/PMC/PMC10418317
  19. Li J, Pan X, Wang Z, et al. Interventions to support the return to work for individuals with stroke: a systematic review and meta-analysis. Journal of Occupational Rehabilitation, 2024. europepmc.org/article/MED/38512392
  20. National Institute for Health and Care Excellence. Stroke rehabilitation in adults (NG236). NICE, 2023. nice.org.uk/guidance/ng236
  21. Nolan JP, Sandroni C, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2025: post-resuscitation care. Resuscitation, 2025. europepmc.org/article/MED/41117575