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The impact of coronary heart disease on life and work 

The impact of coronary heart disease on life and work

Chapter:
The impact of coronary heart disease on life and work
Author(s):

Michael C. Petch

DOI:
10.1093/med/9780199204854.003.161308_update_002

Update:

This chapter has been retired and will not be updated further. The subject matter of this chapter is to be found in chapters 16.13.4, 16.13.5, 16.13.6, and 16.13.7 of this online update.

Updated on 29 Oct 2015. The previous version of this content can be found here.
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date: 30 March 2017

Coronary heart disease is common and lethal: these facts are well known and have a profound influence on attitudes of victims and others—their families, friends, and employers.

The presence of heart failure and/or significant areas of cardiac ischaemia is the principal determinant of prognosis, and can be best judged by history, examination, and noninvasive testing, with common sense and experience being the best tools for assessing an individual’s fitness to resume life and work following the development of coronary heart disease.

Following a cardiac event such as myocardial infarction or coronary artery bypass grafting, patients with an acceptable exercise response are often enrolled into a rehabilitation programme. Following myocardial infarction or unstable angina, those with no complications and good exercise tolerance may return to work in about 4 weeks.

The risk of sudden disability and death through ventricular fibrillation is the major factor affecting work capacity amongst victims of coronary heart disease. Workers whose sudden incapacity would place themselves and others at risk are described as being in ‘safety-critical’ jobs. The best approach to determine whether someone should be able to return to work is to define what level of risk is acceptable, and then decide whether their medical condition places them within the predetermined limits of acceptability. The Civil Aviation Authority was the first to adopt this approach with what is now known as the ‘1% rule’, based on assumptions and calculations indicating that a pilot with a 1% annual risk of a cardiac event has the same risk of ‘failing’ when flying as other elements of the aircraft.

Ordinary driving may be resumed 1 month after a cardiac event, provided that the driver does not suffer from angina that may be provoked at the wheel. Vocational driving may be permitted at 6 weeks, subject to a satisfactory outcome from noninvasive testing.

Despite modern treatments, some patients will experience multiple coronary events that eventually lead to extensive ventricular damage: they—with their partners, if appropriate—should be given the opportunity of a frank discussion about their prognosis, but some would rather not know and that attitude should be respected.

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