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Objective This study aims to assess the self-efficacy of returning to work among middle-aged and young patients with aortic dissection. Additionally, it seeks to identify distinct characteristics of these patients using latent profile analysis based on their return-to-work self-efficacy (RTW-SE) levels and to explore factors influencing the identified latent subgroups.Design A cross-sectional study.Setting Data were collected from a Class III Grade A hospital in Fujian Province, China.Participants A total of 204 patients were recruited for this study.Outcome measures Data collection used a self-generated general information questionnaire, RTW-SE, Fear of Progression Questionnaire-Short Form and Social support rate scale.Results A total of 204 young and middle-aged patients with aortic dissection were classified into three categories based on their RTW-SE: high work coping–high internal coping group (9.8%), moderate overall level group (38.2%) and low work coping–low internal coping group (52.0%). Multivariate logistic regression analysis identified personal annual income, type of employment, education level and fear of disease progression as significant factors influencing RTW-SE in these patients (p<0.05).Conclusion A significant proportion of aortic dissection patients exhibit low self-efficacy in returning to work. These findings underscore the importance of emphasising vocational rehabilitation and integrating it into comprehensive cardiac rehabilitation programmes.