The work evaluation of the cardiac patient

Treadmill exercise testing performed three weeks following clinically uncomplicated myocardial infarction was used to assess the occupational work potential of 196 men aged 70 or less. Within the six months after infarction the rate of combined medical and surgical events (sudden death, nonfatal cardiac arrest, myocardial infarction or coronary artery bypass graft surgery) was 34% in the one-quarter of patients judged to be at high risk and 4% in the three-quarters of patients judged to be at low risk on the basis of exercise testing--an eight-fold difference. Seven weeks or more after infarction, treadmill testing or leg-cranking ergometry proved more sensitive than static effort or arm cranking or treadmill exercise combined with static effort in the detection of ischemic and arrhythmic abnormalities. Occupational work assessment may limit costs for postinfarction patients in two ways: (1) by facilitating optimal usage of diagnostic tests and therapeutic interventions in high-risk patients; and (2) by obviating needless delay in the return to work of low-risk patients.