Return to work with heart disease

Cardiovascular disease is the leading cause of death in developed countries (40% of all causes of mortality). Heart disease is common in the working age population and thus it contributes to a decline in employees' fitness for work. In Israel about 80% of patients recuperating from myocardial infarction (MI) return to work. However, long term employment may be as low as 50% and its patterns are associated predominantly with patient age and job characteristics, as compared to measures of illness severity or the method of coronary revascularization. The need for clinical guidelines in the management of return to work after myocardial infarction has recently led to the initiation of a joint committee of the Israeli National Heart and Occupational Societies. These clinical guidelines have been published and are summarized in this issue. For most common cardiac disease, including heart failure, valve disease and angina, patients can exert themselves up to onset of symptoms. Therefore, patients with functional capacity I and II, as estimated by New York Heart Association (NYHA) criteria, can return to their previous work. Timing of return to work for patients with asymptomatic uncomplicated cardiac disease: Post MI within 4 weeks, CABG within 4-8 weeks and percutaneous interventions within 1 week. For patients with a strenuous job or in NYHA functional capacity III or IV, a few weeks of delay and exercise or other functional testing may be needed. There are a few exceptions including patients with strenuous work or specific cardiac diseases as hypertrophic cardiomyopathy, severe aortic stenosis and Marian's syndrome. In such cases, cardiological and occupational specialist advice should be sought.