Working (returning to work and heart disease)

Clinical aspects to consider:

For most common cardiac disease, including heart failure and angina, patients can exert themselves up to, but not beyond, the point of onset of symptoms. There are a few exceptions including patients with some forms of hypertrophic cardiomyopathy, severe aortic stenosis, and Marfan's syndrome, for whom specialist advice should be sought.

Timing of return to work:

• This information is only a guide to doctors, who will need to consider the individual clinical circumstances when advising patients
• should return to work as soon as they feel psychologically and physically capable of doing so. Target times for patients with asymptomatic uncomplicated cardiac disease:
  • myocardial infarction: 4-6 weeks (1)
    • in most cases, returning to work after MI should not be delayed beyond 3 months as a successful return is less likely as time goes on (1)
  • coronary artery bypass grafting: 6-12 weeks in general
    • with respect to returning to work following a CABG:
      • Every person recovers differently and has different needs. If you do a job which involves only light physical exertion - i.e., it does not involve you standing for periods of more than 20 minutes, or lifting more than 5kg at a time - you can usually return to work 6-8 weeks after your operation. Most people will find themselves fit to work by two to three months after the operation (2)
      • An online occupational health resource suggests that (3)
        • a return to work of 12-39 weeks if "heavy manual" work
        • a return to work of 26-39 weeks if "physically demanding" work
  • angioplasty (4)
    • with respect to returning to work following a coronary angioplasty:
      • "..If you have had an angioplasty that was planned in advance, and there were no complications, you may be able to return to work within a few days, depending on the type of work you do. If you had an angioplasty as an urgent treatment for acute coronary syndrome, it’s likely that you will need to wait longer than this before going back to work. If you have had a heart attack, you may need to take a few weeks off work, or longer if you have a manual job."
• patients who have suffered a cardiac arrest or undergone CABG generally take longer to recover physically and cognitively and may require up to 6 months off work (1)
• cardiac rehabilitation programmes should include work assessment and advice
  • assessment may simply involve listing the tasks involved in the job and grading them in order of difficulty
  • occasionally a more detailed assessment in the work place may be required
  • where exercise tolerance is reduced or the work is physically demanding it may be helpful to undertake a programme of 'work-hardening' as part of the rehabilitation programme (1)
  • the aim should be to devise a return to work plan which will minimise the impact of symptoms such as fatigue or poor concentration, thereby increasing the confidence of both patient and employer
  • advice to the patient should include (1):
    • phased return to work beginning with alternate half days - a plan where the patient's work return builds up over a 2-3 week period should be encouraged
    • initially returning to light or less challenging duties
    • making provision for additional rest periods where fatigue is a known problem or return to work has been delayed
    • providing a mechanism for feedback on performance from the employer or a member of staff

Legal Aspects:

• certain occupations e.g. vocational driving, are governed by statutory health standards

Notes (5):

• currently there is a lack of uniform European guidelines or practical recommendations to guide physicians improving the (long-term) success rate of RTW (return to work) after a cardiac event
• in current era of extensive invasive and medical treatment of ACS, the majority of ACS patients have only limited cardiac damage and are usually only a few days in hospital without major complications
  • these patients can usually also return to work after a period of cardiac rehabilitation - however, a significant proportion of ACS patients may experience problems in the process of returning to work
• in order to estimate the chance of successfully returning to the same level of work after an ACS, an evaluation of medical, psychosocial and work-related factors should be performed

References:

1. British Heart Foundation (Factfile). Returning to work after a heart attack.
2. Royal College of Surgeons of England.
3. http://www.workingfit.com (accessed 2/12/2020)
4. British Heart Foundation. Coronary angioplasty.HIS10/0318 (8/5/2018)
5. Bresseleers J, De Sutter J. Return to work after acute coronary syndrome: Time for action. European Journal of Preventive Cardiology 2019, Vol. 26(13) 1355–135