Occupational work evaluation of patients with cardiac disease: a guide for physicians

The capacity of cardiac patients to work in their occupations reflects a complex interaction of medical and nonmedical factors. Medical considerations include prognosis and the ability of patients to tolerate the physical, environmental and psychological aspects of their occupation. Nonmedical factors include the patient's satisfaction with the job, economic motivation to work and perceived risk of continued work. Patients' perceptions of their capacity to work and the risks of such work are especially important determinants of occupational work status after myocardial infarction and coronary operations. Symptom-limited treadmill exercise testing carried out three to four weeks after the acute event not only clarifies prognosis and quantitates functional capacity but helps patients to realistically assess their capacity for work. Approximately half of postinfarction patients are found by such testing to have a very low first-year mortality of less than 2 percent. Functional capacity is well maintained in these patients: they do not require formal reconditioning in order to resume their occupational work soon (three to five weeks) after infarction. Exercise testing performed soon after myocardial infarction and coronary artery operation affords practical guidelines for clearing a person to return to work and obviates much of the medically unwarranted disability that follows these events.