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RETURNING TO WORK WITHOUT HASSELS OR FEARS AFTER HEART ATTACK: MEDICAL AUTHORITIES DRAW RETURN-TO-WORK GUIDELINES
In 1989 a 70-member blue-ribbon panel of cardiologists, other health professionals, psychologists and sociologists, along with representatives from industry and insurance companies, drew up a set of guidelines regarding patients’ return to work following a cardiac event. The panel, headed by Dr Robert DeBusk, director of the cardiac rehabilitation program at Stanford University, published their recommendations in the Journal of the American College of Cardiology:
Most occupations don’t increase the risk of heart disease.
A clinical examination and testing to evaluate left ventricular function, heart muscle at risk and oxygen deficit to the heart muscle can be easily performed in most cases to provide an accurate prognosis. Cardiac catheterisation is not usually necessary.
Those whose occupations call for sudden or sustained high levels of physical effort, or exposure to temperature extremes, should be thoroughly evaluated.
Based on such evaluations, most patients can be advised to go straight to full-time work. But some may need a gradual comeback or a trial period.
Those whose work involves or potentially endangers the lives of others (such as air traffic controllers) should be carefully evaluated.
The patient’s functional capacity should be evaluated as soon as he or she becomes stable. That generally means five weeks after an uncomplicated heart attack, seven weeks following bypass, and one week after angioplasty. This will determine any abnormal responses to exercise. A full treadmill stress test at six months will be more definitive. Assuming that cardiac rehabilitation efforts have been faithfully followed, one can assume that the six-month stress test will show significant improvement and work capacity.
If routine testing procedures don’t give clear-cut information, more definitive measurements should be performed, including, perhaps, angiography.
Psychological profiles, including reactions to stress and Type-A behaviour patterns, should be taken.
If necessary, appropriate tranquillising medications can be prescribed. Others may respond well to psychological counselling.
Dr DeBusk, who is considered to be one of the world’s authorities on this aspect of cardiac rehabilitation, stressed the importance of the doctor-patient relationship. The doctor should spend significant and adequate time with the patient to discuss return to work, providing guidelines which should instil confidence and allay fears.
We’re going to talk more about the importance of that doctor-patient relationship, and how to make sure you get the best possible treatment and counselling, in the next chapter.
Not only should most heart patients return to work, but also they can and perhaps should do so sooner rather than later. For openers, surveys have shown that putting off a return to work lessens the odds that the patient will return at all. The quicker you get back to a routine lifestyleЂ”and that includes workЂ”the better your chances for complete recovery.
Dr DeBusk and his associates at Stanford studied the benefits of an occupational work evaluation in terms of shortening the time to return to work. About 200 patients recovering from an uncomplicated heart attack were assigned to one of two groups. In the first, they were given occupational work evaluation consisting of a symptom-limited treadmill test performed about 23 days after the heart attack and a formal recommendation to the patient and primary physician that the patient could return to work within the next two weeks. The other group received usual care, without the emphasis on work. There was no difference in age, medical status or occupation between the groups.
By the end of six months, 92 per cent of those getting the testing and encouragement had returned to work, while 88 per cent of those who did not get the additional attention also were back on the job. That’s not a big difference. But: return to full-time work occurred at an average of 51 days in those receiving special intervention, and 75 days in patients getting usual care. This 32 per cent cut in recovery time meant an average of $2102 in additional income! There were no more complications in the group that went back to work earlier. Couldn’t you use an extra two grand?
Cardio & BloodThe American Heart Association has come up with a very complete way of making recommendations for both recreational and occupational activity. The following breakdown for patient recommendations was published in the 5 November 1986 issue of Circulation, the AHA’s official publication.
Take a copy of it to your doctor and ask that he or she fill in the appropriate blanks. Then you’ll “have it in writing” as to what your limitations and restrictions, if any, are, and you can proceed to live your life to its fullest.
*51/85/2*
