Appendix B
Literature Review

A review of the published literature related to disability was conducted to examine current evidence of cardiovascular conditions and employment capability. The primary strategy included database searches using keywords and Medical Subject Headings (MeSH), yielding initial results of 14,642 studies published between 1980 and October 2009. The studies were reviewed, analyzed, and coded according to a tiered category system. A secondary search strategy included a manual review of references cited in key articles as well as searches executed in PubMed using key terms. Final results included 35 relevant studies for detailed review. Topics of discussion among the relevant studies include frequency of returning to work following an acute myocardial infarction, physical disability in populations with peripheral artery disease, and the impact of job strain and depressive symptoms on return to work after acute coronary syndrome.

METHODS

The primary strategy of the literature review was to search four databases: Medline, EMBase, Web of Science, and PsychINFO. Together these databases contain information on research related to medicine, nursing, health care delivery, psychiatry, sociology, and psychology. Search strategies were developed for each database using text and MeSH terms in groups focused on each of the listing-level cardiovascular conditions (chronic heart failure, ischemic heart disease, recurrent arrhythmias, symptomatic congenital heart disease, heart transplant, aneurysm of the aorta and major branches, chronic venous insufficiency, and peripheral artery



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Appendix B Literature Review A review of the published literature related to disability was conducted to examine current evidence of cardiovascular conditions and employ- ment capability. The primary strategy included database searches using keywords and Medical Subject Headings (MeSH), yielding initial results of 14,642 studies published between 1980 and October 2009. The studies were reviewed, analyzed, and coded according to a tiered category system. A secondary search strategy included a manual review of references cited in key articles as well as searches executed in PubMed using key terms. Final results included 35 relevant studies for detailed review. Topics of discus- sion among the relevant studies include frequency of returning to work following an acute myocardial infarction, physical disability in populations with peripheral artery disease, and the impact of job strain and depressive symptoms on return to work after acute coronary syndrome. METHODS The primary strategy of the literature review was to search four da- tabases: Medline, EMBase, Web of Science, and PsychINFO. Together these databases contain information on research related to medicine, nurs- ing, health care delivery, psychiatry, sociology, and psychology. Search strategies were developed for each database using text and MeSH terms in groups focused on each of the listing-level cardiovascular conditions (chronic heart failure, ischemic heart disease, recurrent arrhythmias, symp- tomatic congenital heart disease, heart transplant, aneurysm of the aorta and major branches, chronic venous insufficiency, and peripheral artery 4

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4 4 CaRdIoVaSCUlaR dISabIlIty disease) and seven separate evaluation sets: disability, employment, quality of life, functional capacity, treatment outcomes, severity of impairment, and comorbidities. Unique terms were identified in each subject area to yield a wide ar- ray of results. Strategy parameters included limiting the search to human subjects, the English language, and publication years from 1980 to Octo- ber 2009. This time period was chosen to ensure the most relevant studies were captured that examined employment capability of populations with cardiovascular conditions. For those evaluation sets reviewing functional capacity, treatment outcomes, and severity of impairment, the parameters were further limited to results published from 2004 to focus on the most recent medical and science literature. The secondary strategy of the literature review involved reviewing key articles’ cited references. Additionally, the PubMed database was searched using Boolean logic with the main term of cardiovascular and key terms related to employment, that is, return to work. Studies were published from 1966 to 2009. Other literature supplemented the body of relevant research supporting the committee’s research and report writing, resulting from targeted searches performed on an ad hoc basis to answer specific research questions. PRELIMINARY ANALYSIS AND RESULTS A tiered category system was developed to refine results. A rigorous review of study titles and abstracts determined which studies met the inclu- sion criteria. Each study was coded according to the corresponding tier (see Box B-1). The primary search strategy yielded 85 studies in Tier 1; after removing duplicate articles produced from the primary search strategy, the secondary strategy yielded an additional 88 studies, for a total of 173 Tier 1 studies. To refine these results, the parameters were further limited to focus on studies published between 2004 and 2009, producing the final results of the literature review of 35 Tier 1 articles. Table B-1 provides a more detailed review of the final Tier 1 studies. An additional 674 articles were identified as Tier 2 articles, which were reviewed to potentially inform the broader parameters affecting functional capacity of populations with cardiovascular diseases leading to disability. These parameters include relative quality of life (with specific measure- ments for health-related quality of life), comorbid conditions, gender com- parisons, and assessments of treatments for cardiovascular conditions or associated conditions that may lead to disability or impairment. The com- mittee determined the Tier 2 studies were not immediately relevant to the statement of work, and few of the studies were included in the final report. The remaining studies were categorized as Tier 3 and 4 studies. Tier 3 stud-

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4 aPPEndIx b ies were available to inform background research during report writing as necessary. Tier 4 studies do not meet the inclusion criteria and were not included in the study process. BOX B-1 Definition of Tiers Tier 1:  Studies  on  clinical  measures  of  treatment  outcomes,  diagnostic  tech- niques, or health status indicators as they relate to employment capability (i.e.,  return to work, employability) for populations with cardiovascular disease diagno- ses that may lead to disability Tier 2:  Studies  on  one  or  more  parameters  of  disability  (e.g.,  comorbid  condi- tions,  quality  of  life,  mortality)  as  they  affect  functional  capacity  for  populations  with cardiovascular conditions Tier 3:  Studies on disability or employment factors that do not explicitly address,  measure, or estimate medical treatment or functional capacity of populations with  cardiovascular conditions (i.e., studies on predictors of disease including employ- ment status, job stress, or demographic values such as race, age, or gender) Tier 4:  Studies not related to cardiovascular disease disability and employment

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0 0 CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Literature Table of Cardiovascular Employment and Disability Articles Sample Study Study Type Time Frame Size Abbas, A. E., B. Brodie, G. Stone, Observational Unknown 900 D. Cox, A. Berman, S. Brewington, S. Dixon, W. W. O’Neill, and C. L. Grines. 2004. Frequency of returning to work one and six months following percutaneous coronary intervention for acute myocardial infarction. american Journal of Cardiology 94(11):1403–1405. Brisson, C., R. Leblanc, R. Observational October 1995– 990 Bourbonnais, E. Maunsell, G. R. November 1997 Dagenais, M. Vezina, B. Masse, and E. Kroger. 2005. Psychologic distress in postmyocardial infarction patients who have returned to work. Psychosomatic medicine 67(1):59–63. Crossland, D. S., S. P. Jackson, R. Observational Unknown 299 Lyall, J. Burn, and J. J. O’Sullivan. 2005. Employment and advice regarding careers for adults with congenital heart disease. Cardiology in the young 15(4):391–395. Earle, A., J. Z. Ayanian, and J. Observational 1996 289 Heymann. 2006. Work resumption after newly diagnosed coronary heart disease: Findings on the importance of paid leave. Journal of Women’s health 15(4):430–441.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Telephone survey at 1- and Angiography; demographic 51% of the study population 6-month follow-ups to and clinical characteristics; returned to work within 1 determine rates of return employment status pre- month of the myocardial to work in population and post-acute myocardial infarction. Predictors of early of myocardial infarction infarction and percutaneous return to work included patients who received coronary intervention employment in the United percutaneous coronary States (study population was intervention international), no history of smoking, and single-vessel coronary disease. At 6 months follow-up, 78% of the population had resumed work. Psychiatric Symptom Index Prevalence of psychologic Psychological distress is (French version) distress in women and men significantly more prevalent after return to work post- in return to work post- myocardial infarction myocardial infarction patients versus general working population. Questionnaire Severity of disease; rates Receiving career advice was of employment; rates of associated with return to work receiving career advice and and maintaining employment education among study participants. Cardiac survey; employment New diagnosis of myocardial 79% of women return status; bivariate chi-square infarction or angina in to work after myocardial and logistic regression the 2 years prior; health infarction or angina. Women analyses condition/behavior; severity with paid leave are more likely of condition; social support; to return to work. Indicators demographic characteristics of a severity of health condition (i.e., myocardial infarction or participation in cardiac rehabilitation) reduced the likelihood of return to work. Higher socioeconomic status and more education increased likelihood of employment. continued

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  CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Continued Sample Study Study Type Time Frame Size Ellis, J. J., K. A. Eagle, E. M. Kline- Observational July 1999– 158 Rogers, and S. R. Erickson. 2005. November 2002 Perceived work performance of patients who experienced an acute coronary syndrome event. Cardiology 104(3):120–126. Ezekowitz, J. A., D. S. Lee, J. V. Observational April 1999–March 9,943 Tu, A. M. Newman, and F. A. 2001 McAlister. 2008. Comparison of one-year outcome (death and rehospitalization) in hospitalized heart failure patients with left ventricular ejection fraction > 50% versus those with ejection fraction < 50%. american Journal of Cardiology 102(1):79–83. Farkas, J., K. Cerne, M. Lainscak, Observational 1999–2002 74 and I. Keber. 2008. Return to work after acute myocardial infarction— Listen to your doctor! International Journal of Cardiology 130(1): e14-e16. Fonarow, G. C., W. G. Stough, Observational Unknown 41,267 W. T. Abraham, N. M. Albert, M. Gheorghiade, B. H. Greenberg, C. M. O’Connor, J. L. Sun, C. W. Yancy, J. B. Young, and OPTIMIZE-HF 2007. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure—A report from the OPTIMIZE- HF registry. Journal of the american College of Cardiology 50(8):768–777.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Mailed survey to patients Health status (SF-8, Current employment is discharged from university- PCS-8, MCS-8, EQ-5D), associated with higher work affiliated hospital with cardiac function status performance post acute diagnosis of acute coronary (Duke Activity Status coronary syndrome event. syndrome during a 3-year Index), symptom count, period comorbidity index, patient-perceived cardiac disease severity, medication count and compliance, job satisfaction, current employment duration, patient demographics, acute coronary syndrome type Discharge medication Rehospitalization or ACE inhibitors, compared with outcome mortality within 1 year spironolactone, and statins measures are associated with better outcomes in patients with heart failure who have been hospitalized. Questionnaire Physical, sociodemographic, Controlling for other psychological factors; variables, only physicians’ return to work following advice was associated with myocardial infarction return to work. Web-based registry; Pearson Preserved systolic function if ACC/AHA performance chi-square test and Wilcoxon ejection fraction documented measure application: as ≥ 40% or qualitatively test analyses adherence to measures more normal or mildly impaired; frequent with left ventricular left ventricular systolic systolic dysfunction; influence dysfunction if ejection of pharmacologic therapy: fraction < 40% or moderate/ preserved systolic function— severe left ventricular no relationship with beta- dysfunction by qualitative blocker or ACE inhibitor, assessment left ventricular systolic dysfunction and beta-blocker experienced significantly lower risk all-cause mortality at 60- to 90-day follow-up. continued

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4 4 CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Continued Sample Study Study Type Time Frame Size Fonarow, G. C., W. T. Abraham, Observational March 2003– 5,791 N. M. Albert, W. G. Stough, M. December 2004 Gheorghiade, B. H. Greenberg, C. M. O’Connor, K. Pieper, J. L. Sun, C. Yancy, and J. B. Young. 2007. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. Journal of the american medical association 297(1):61–70. Fukuoka, Y., K. Dracup, M. 6-month January 2004– 240 Takeshima, N. Ishii, M. Makaya, prospective March 2006 L. Groah, and E. Kyriakidis. 2009. longitudinal study Effect of job strain and depressive symptoms upon returning to work after acute coronary syndrome. Social Science & medicine 68(10):1875–1881. Geyer, S., K. Norozi, R. Buchhorn, Observational April 2003– 314 and A. Wessel. 2009. Chances of January 2004 employment in women and men after surgery of congenital heart disease: Comparisons between patients and the general population. Congenital heart disease 4(1):25–33. Grady, K. L., P. M. Meyer, D. Observational August 1994– 40 Dressler, C. White-Williams, A. August 1999 Kaan, A. Mattea, S. Ormaza, S. Chillcott, A. Loo, B. Todd, M. R. Costanzo, and W. Piccione. 2003. Change in quality of life from after left ventricular assist device implantation to after heart transplantation. Journal of heart & lung transplantation 22(11):1254–1267.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Multivariable and Rehospitalization or Current heart failure propensity-adjusted analyses mortality rates 60 to 90 performance measures have to assess process-outcome days post-discharge little relationship with patient relationship for each mortality and hospitalization performance measure in 60–90 days post-discharge. Follow-up at 3 and 6 Job strain/characteristics; Even mild depressive months; mailed written Beck Depression symptoms were a strong questionnaires; BDI-II; Job Inventory II predictor of delay or failure to Content Questionnaire; return to work. Duke Activity Status Index Examined relationship Classification by type of Likelihood of full-time between disease severity surgery (curative, reparative, employment decreases as and employment status palliative) as indicator of disease severity increased. disease severity; classified by New York Heart Association system Quality of Life Index, Quality of life at 3 months Patients were significantly Rating Question Form, post-LVAD versus more satisfied with quality of Heart Failure Symptom 3 months post-heart life after heart transplantation Checklist, Sickness Impact transplant compared with LVAD; Profile, Left Ventricular mobility, self-care, physical Assist Device (LVAD) ability, and overall functioning Stressor Scale, Heart were more improved in Transplant Stressor Scale, transplant group Jalowiec Coping Scale continued

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  CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Continued Sample Study Study Type Time Frame Size Grady, K. L., D. C. Naftel, J. K. Observational Unknown 311 Kirklin, C. White-Williams, J. Kobashigawa, J. Chait, J. B. Young, D. Pelegrin, K. Patton-Schroeder, B. Rybarczyk, J. Daily, W. Piccione Jr., and A. Heroux. 2005. Predictors of physical functional disability at 5 to 6 years after heart transplantation. Journal of heart and lung transplantation 24(12):2279–2285. Holper, E. M., J. Blair, F. Selzer, Randomized July 1997– 4,697 K. M. Detre, A. K. Jacobs, controlled trial February 1998; D. O. Williams, H. Vlachos, R. L. February Wilensky, P. Coady, D. P. Faxon, 1999–July 1999; Registry Percutaneous Transluminal October 2001– Coronary Angioplasty, and March 2002 Investigators Dynamic Registry. 2006. The impact of ejection fraction on outcomes after percutaneous coronary intervention in patients with congestive heart failure: An analysis of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry. american heart Journal 151(1):69–75. Incalzi, R. A., A. Corsonello, C. Observational 4 months, 1,271 Pedone, F. Corica, P. Carbonin, and (unknown period) R. Bernabei. 2005. Construct validity of activities of daily living scale: A clue to distinguish the disabling effects of COPD and congestive heart failure. Chest 127(3):830–838.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Sickness Impact Profile, Differences in physical Physical functional disability Quality of Life Index, functional disability at 5 was low at 5 to 6 years Heart Transplant Symptom to 6 years post-transplant; post-transplant; women Checklist, Jalowiec Coping clinical data collected from had more overall physical Scale, Positive and Negative hospital records, clinic functional disability; patients Affect Schedule-Expanded charts, and the Cardiac with comorbidities had more Form, Cardiac Depression Transplant Research physical functional disability; Scale, Assessment of Database and physical functional Problems with the Heart disability was related to Transplant Regimen activities of daily living. Telephone interview by Demographic; angiographic Patients with chronic heart trained nurse assessing and lesion characteristics; failure were older and were symptoms, medication patient-specific procedural more often women and status, and coronary event data, outcomes (ejection African Americans. They fraction values) presented with history of prior myocardial infarction and revascularization, diabetes, hypertension, and other severe concomitant noncardiac disease; lower ejection fraction; more extensive coronary artery disease; higher frequency of triple-vessel disease and total occlusions; and higher mean number of significant lesions. Construct validity for Functional status prehospital COPD is associated with a self-reported activities of admission compared pattern of disability expressed daily living (ADLs) and with assessments of by loss of select ADL/IADLs; instrumental activities of postdischarge; comparing with ADL/IADL cluster daily living (IADLs); chronic obstructive similar in two populations surveys; questionnaires pulmonary disease (COPD) with different chronic and diabetes mellitus conditions (e.g., chronic heart failure and diabetes mellitus); and crude lost IADL may not fully represent loss of personal independence. continued

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  CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Continued Sample Study Study Type Time Frame Size Jalowiec, A., K. L. Grady, and C. Observational Unknown 237 White-Williams. 2007. Functional status one year after heart transplant. Journal of Cardiopulmonary Rehabilitation and Prevention 27(1):24–32. Erratum in: Journal of Cardiopulmonary Rehabilitation and Prevention 2007 27(3):165. Kiessling, A., and P. Henriksson. Observational 2 years (unknown 169 2005. Perceived cognitive function period) in coronary artery disease—An unrecognized predictor of unemployment. Quality of life Research 14(6):1481–1488. Kuoppala, J., and A. Lamminpää. Review N/A N/A 2008. Rehabilitation and work ability: A systematic literature review. Journal of Rehabilitation medicine 40(10):796–804. Lau-Walker, M. O., M. R. Cowie, Observational 3 years (unknown 253 and M. Roughton. 2009. Coronary period) heart disease patients’ perception of their symptoms and sense of control are associated with their quality of life three years following hospital discharge. Journal of Clinical nursing 18(1):63–71. Massie, B. M., J. J. Nelson, M. A. Observational 1 year (unknown 4,280 Lukas, B. Greenberg, M. B. Fowler, period) E. M. Gilbert, W. T. Abraham, S. R. Lottes, J. A. Franciosa, and Cohere Participant Physicians. 2007. Comparison of outcomes and usefulness of carvedilol across a spectrum of left ventricular ejection fractions in patients with heart failure in clinical practice. american Journal of Cardiology 99(9):1263–1268.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Sickness Impact Profile; Pre- and post-transplant 1-year post-transplant paired t-tests; medical and functional scores from predictors of worse functional demographic data on patient Sickness Impact Profile status included greater questionnaire symptom distress, more stressors, neurologic problems, depression, female gender, older age, and lower left ventricular ejection fraction (worse function). Health-related quality of life Gainful employment and Perceived cognitive function questionnaires return to work in patients predicts both prevalence of with coronary artery unemployment and early disease retirement and sick leave due to coronary artery disease. N/A N/A Vocational rehabilitation may help reduce absentee rates; concepts of workplace must be integrated into rehabilitation practices. Questionnaires SF-36 (physical and mental Coronary artery disease summary scores) patients’ perception of their symptoms and sense of control at time of discharge was significantly associated with their quality of life 3 years postdischarge. Comparing beta-blocker Patient status and clinical Patients with preserved carvedilol, characteristics, events provided at baseline, ejection fraction were more carvedilol titration, and end-titration and 6 and likely to be older, female, outcomes of patients 12 months thereafter; and hypertensive; lower left according to left ventricular clinical events defined as ventricular ejection fraction ejection fraction > 40% or hospitalizations, unscheduled was associated with worse < 40% visits functional class and more heart failure hospitalizations in the previous year. continued

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0 0 CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Continued Sample Study Study Type Time Frame Size McBurney, C. R, K. A. Eagle, E. Observational 7 months 89 M. Kline-Rogers, J. V. Cooper, (unknown period) D. E. Smith, and S. R. Erickson. 2004. Work-related outcomes after a myocardial infarction. Pharmacotherapy 24(11):1515–1523. Mital, A., A. Desai, and A. Review N/A N/A Mital. 2004. Return to work after a coronary event. Journal of Cardiopulmonary Rehabilitation 24(6):365–373.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Work-Performance Scale Return to work post- Variables associated with not of the functional Status myocardial infarction returning to work included Questionnaire; health-related past myocardial infarction, quality of life; Physical coronary artery bypass Component Summary graft, heart failure, positive (PCS-12) stress test, low score on the PCS-12 scale of the SF-12; patients who did not return to work also tended to have more comorbidities and take more prescribed drugs; median WPS scores were higher for patients who had higher ejection fraction at discharge, had not experienced a previous myocardial infarction, underwent a percutaneous revascularization intervention at the time of hospitalization, and had not recently been absent from work; and workers reporting absence from work had lower PCS-12 scores or reported rehospitalization. N/A N/A Patients with coronary artery bypass graft indicate likelihood to return to work based on information other than cardiac findings: education level (higher, more likely), work history (high stress, less likely), gender (men, more likely), age (older, less likely), and psychological factors (depressive mood, less likely). continued

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  CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Continued Sample Study Study Type Time Frame Size O’Connor, C. M., D. J. Whellan, Randomized April 2003– 2,331 K. L. Lee, S. J. Keteyian, L. S. controlled trial February 2007 Cooper, S. J. Ellis, E. S. Leifer, W. E. Kraus, D. W. Kitzman, J. A. Blumenthal, D. S. Rendall, N. H. Miller, J. L. Fleg, K. A. Schulman, R. S. McKelvie, F. Zannad, I. L. Pina, and HF-ACTION Investigators. 2009. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. Journal of the american medical association 301(14):1439–1450. Paris, W., and C. White-Williams. Review N/A N/A 2005. Social adaptation after cardiothoracic transplantation: A review of the literature. Journal of Cardiovascular nursing 20(Suppl 5): S67–S73. Petrucci, R. J., K. C. Truesdell, A. Observational January 1984– 252 Carter, N. E. Goldstein, M. M. December 2002 Russell, D. Dilkes, J. M. Fitzpatrick, (18 years) C. E. Thomas, M. E. Keenan, L. A. Lazarus, N. D. Chiaravalloti, J. J. Trunzo, J. W. Verjans, E. C. Holmes, L. E. Samuels, and J. Narula. 2006. Cognitive dysfunction in advanced heart failure and prospective cardiac assist device patients. annals of thoracic Surgery 81(5):1738–1744. Phillips, L., T. Harrison, and P. Review N/A N/A Houck. 2005. Return to work and the person with heart failure. heart & lung 34(2):79–88.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Multicenter randomized Rehospitalization; all-cause There were nonsignificant controlled trial; aerobic mortality reductions in outcomes for exercise training for patients primary group; authors with chronic heart failure propose reasons in the discussion; exercise training is associated with significant reductions for both all-cause mortality or hospitalization and cardiovascular mortality or heart failure hospitalization; exercise training was well tolerated and safe. N/A N/A Describes social adaptation for heart, lung, and heart–lung transplant recipients; less than half of recipients who are physically able to work are employed; patients who do not resume working within first year less likely to return to work at all. New York Heart Association Memory, motor, and Cognitive deficits are common Stage III to IV symptomatic processing speed; in advanced heart failure left ventricular ejection neuropsychological exam and worsen with increasing fraction < 20% requiring severity of heart failure. frequent hospitalization for worse heart failure and neuropsychological exam N/A N/A Nurses may be a necessary and important advocate for patients with heart failure. Nurses should be available to assess, provide resources. Additional research is needed for safe transition for heart failure patients to workforce. continued

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4 4 CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Continued Sample Study Study Type Time Frame Size Poston, R. S., R. Tran, M. Collins, Observational January 2005– 200 M. Reynolds, I. Connerney, B. June 2007 Reicher, D. Zimrin, B. P. Griffith, and S. T. Bartlett. 2008. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. annals of Surgery 248(4):638–646. Reynolds, M. W., D. Frame, R. Review N/A N/A Scheye, M. E. Rose, S. George, J. B. Watson, and M. A. Hlatky. 2004. A systematic review of the economic burden of chronic angina. american Journal of managed Care 10(Suppl 11):S347–S357. Rollman, B. L., B. H. Belnap, M. S. Randomized 8 months 450 LeMenager, S. Mazumdar, H. C. controlled trial (unknown period) Schulberg, and C. F. Reynolds III. 2009. The Bypassing the Blues treatment protocol: Stepped collaborative care for treating post- CABG depression. Psychosomatic medicine 71(2):217–230. Ruel, M., A. Kulik, B. K. Lam, Observational 1976–2002 500 F. D. Rubens, P. J. Hendry, R. G. Masters, P. Bédard, and T. G. Mesana. 2005. Long-term outcomes of valve replacement with modern prostheses in young adults. European Journal of Cardiothoracic Surgery 27(3):425–433.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Examine the efficacy of Patient satisfaction; post- Mini-coronary artery bypass mini- versus standard- operative clinical data; graft shortens patient recovery coronary artery bypass demographics time, minimizes MACCE risk graft. Patients prescreened at 1 year, and shows superior and interviewed 3- and 12- quality and outcome metrics months post major adverse versus standard coronary cardiac and cerebrovascular artery bypass graft; there are event (MACCE) higher return to work rates and/or normal activities in a significantly shorter period of time. N/A N/A Chronic angina may require substantial costs caused by frequent hospitalizations and expensive revascularization procedures. Angina also causes substantial workplace productivity loss. Long-term and lasting improvement in work status is difficult to achieve. 300 patients with depressive Mood symptoms, To be determined. symptoms post-coronary cardiovascular morbidity, artery bypass graft employment, health services (PHQ-9) and 100 use, and treatment costs nondepressed patients, measured by SF-36 Mental Component Summary score Primary valve replacement, Mortality, stroke, bleeding Late outcomes of modern either aortic or mitral events, reoperation, heart prosthetic valves in young failure, other prosthesis- adults remain suboptimal; related complications, bioprostheses deserve quality of life consideration in the aortic position, as mechanical. continued

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  CaRdIoVaSCUlaR dISabIlIty TABLE B-1 Continued Sample Study Study Type Time Frame Size Vohra, R. S., P. A. Coughlin, and Observational February 2001– 139 M. J. Gough. 2007. Occupational February 2005 capacity following surgical revascularization for lower limb claudication. European Journal of Vascular and Endovascular Surgery 34(6):709–713. White-Williams, C., A. Jalowiec, Observational Data collection 237 and K. Grady. 2005. Who returns ended in 1997 to work after heart transplantation? Journal of heart & lung transplantation 24(12):2255–2261.

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 aPPEndIx b Methodology Outcome Measures Relevant Findings Questionnaires Employment status after Two-thirds of potentially procedure (lower limb employable patients with revascularization) claudication return to work following surgery. Factors influencing decision to return to work include age, type of procedure, and preoperative occupation. Work history tool, rating Work history, quality-of-life 81% of participants question form, heart outcomes collected at time maintained employment transplant stressor scale, of enrollment and 1-year status post-transplant. quality of life index, post-transplant; functional Those who did not work Sickness Impact Profile, status measured with the prior to transplant did not Jalowiec Coping Scale, Sickness Impact Profile; work post-transplant. Those social support index, Heart Transplant Stressor who worked before surgery heart transplant symptom Scale developed for this maintained employment checklist, and chart study measures perceived after surgery. Twenty-one review form; frequency stressful nature of issues patients returned to work distributions, chi-square, related to HF and trans- post-transplant, on average t-tests, and stepwise plant; Quality of Life resuming work 4.8 months regression analysis and Jalowiec Coping post-surgery. Ejection fraction Scale measure patient life did not differ significantly satisfaction and coping among those working and mechanisms those not working. Those who returned to work were mostly white-collar, business/ executive employees; those who did not return to work included mostly sales clerks, technicians, and factory workers.

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