The real cost of a heart attack or stroke is twice the direct medical expense when lost work time for patients and caregivers is included, say scientists..

Victims who return to their jobs are 25 per cent less productive in the first year back, according to new research.

Heart patients were absent for roughly 59 days with the average cost across seven European nations - including the UK - 13,953 Euros (£11,931).

This ranged from 6,641 to 23,160 Euros (£5,678 to £19,806) depending on the country. Spouses or other carers were away for eleven.

For stroke, 56 workdays were lost by patients for an average of 13,773 Euros (£11,775) - spanning from 10,469 to 20,215 Euros (£8,952 to £17,283). For carers, it was 12.

Study author Professor Kornelia Kotseva, of Imperial College London, said: "Patients in our study returned to work, meaning their events were relatively mild.

"Some still had to change jobs or careers, or work less, and caregivers lost around five per cent of work time.

"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."

The study, published in the European Journal of Preventive Cardiology, was based on 394 patients in the UK, Belgium, France, Poland, Portugal, Spain and Switzerland.

Among the participants, 196 had acute coronary syndrome such as a heart attack (86 per cent) or chest pain (14 per cent). The other 198 had suffered a stroke.

They had returned to work three to 12 months after the event and completed a questionnaire during a visit to a cardiologist, neurologist or stroke physician.

Hours lost were valued according to country labour costs in 2018. The average age of participants was 53.

It is estimated the direct medical costs of acute coronary syndrome in Europe are between 1,547 and 18,642 Euros (£1,325 to £15,969) and 5,575 to 31,274 Euros (£4,778 to £26,807) for stroke.

Prof Kotseva said: "This is the metric commonly used to estimate the costs of medical conditions while indirect costs from productivity loss are often not taken into account by clinicians, payers or policymakers.

"Taken together, the actual burden on society is more than twice the amount previously reported."

Reasons for lost productivity were consistent across countries with 61 percent for the initial hospitalisation and sick leave after discharge, 23 to 29 percent absence afterwards and 9 to 16 percent being unable to work at full capacity because of feeling unwell.

Even more workdays were lost in the first year after the event for patients with previous events or established cardiovascular disease.

When adding days lost by patients and caregivers together, this was 80 for acute coronary syndrome and 73 for stroke, costing 16,061 and 14,942 respectively (£13,761 and £12,803).

In the study, 27 per cent of heart patients and 20 per cent of stroke patients were obese, while 40 per cent of heart patients and 27 per cent of stroke patients were current smokers.

Prof Kotseva added: "Productivity loss associated with cardiovascular events is substantial and goes beyond the patient.

"Preventing acute coronary syndrome and stroke is the key to improving health and longevity and avoiding the myriad of costs that come with such an event.

"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."

Prof Nana Pogosova, of the National Medical Research Center of Cardiology, Russia, who reviewed the study for the journal, said cardiovascular disease (CVD) is responsible for more deaths worldwide than any other condition.

A large proportion of healthcare budgets is spent on its diagnosis, treatment and prevention. Globally, there were an estimated 422.7 million cases in 2015.

Prof Pogosova said: "The results of the study may be used to inform and populate societal economic evaluations in CVD and also to guide policy-makers who are focused on reducing the overall burden and achieving specific global health targets."

The findings have been released to coincide with World Health Day. There are around seven million people living with heart and circulatory disease in the UK - 3.5 million men and the same number of women.