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
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 array of results. Strategy parameters included limiting the search to human subjects, the English language, and publication years from 1980 to October 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 inclusion 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 measurements for health-related quality of life), comorbid conditions, gender comparisons, and assessments of treatments for cardiovascular conditions or associated conditions that may lead to disability or impairment. The committee 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-
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 techniques, or health status indicators as they relate to employment capability (i.e., return to work, employability) for populations with cardiovascular disease diagnoses that may lead to disability Tier 2: Studies on one or more parameters of disability (e.g., comorbid conditions, 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 employment status, job stress, or demographic values such as race, age, or gender) Tier 4: Studies not related to cardiovascular disease disability and employment |
TABLE B-1 Literature Table of Cardiovascular Employment and Disability Articles
Study |
Study Type |
Time Frame |
Sample Size |
Abbas, A. E., B. Brodie, G. Stone, 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. |
Observational |
Unknown |
900 |
Brisson, C., R. Leblanc, R. Bourbonnais, E. Maunsell, G. R. 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. |
Observational |
October 1995–November 1997 |
990 |
Crossland, D. S., S. P. Jackson, R. 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. |
Observational |
Unknown |
299 |
Earle, A., J. Z. Ayanian, and J. 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. |
Observational |
1996 |
289 |
Methodology |
Outcome Measures |
Relevant Findings |
Telephone survey at 1- and 6-month follow-ups to determine rates of return to work in population of myocardial infarction patients who received percutaneous coronary intervention |
Angiography; demographic and clinical characteristics; employment status pre-and post-acute myocardial infarction and percutaneous coronary intervention |
51% of the study population returned to work within 1 month of the myocardial infarction. Predictors of early return to work included employment in the United States (study population was 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 (French version) |
Prevalence of psychologic distress in women and men after return to work post-myocardial infarction |
Psychological distress is significantly more prevalent in return to work post-myocardial infarction patients versus general working population. |
Questionnaire |
Severity of disease; rates of employment; rates of receiving career advice and education |
Receiving career advice was associated with return to work and maintaining employment among study participants. |
Cardiac survey; employment status; bivariate chi-square and logistic regression analyses |
New diagnosis of myocardial infarction or angina in the 2 years prior; health condition/behavior; severity of condition; social support; demographic characteristics |
79% of women return to work after myocardial infarction or angina. Women with paid leave are more likely to return to work. Indicators 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. |
Study |
Study Type |
Time Frame |
Sample Size |
Ellis, J. J., K. A. Eagle, E. M. Kline-Rogers, and S. R. Erickson. 2005. Perceived work performance of patients who experienced an acute coronary syndrome event. Cardiology 104(3):120–126. |
Observational |
July 1999–November 2002 |
158 |
Ezekowitz, J. A., D. S. Lee, J. V. Tu, A. M. Newman, and F. A. 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. |
Observational |
April 1999–March 2001 |
9,943 |
Farkas, J., K. Cerne, M. Lainscak, and I. Keber. 2008. Return to work after acute myocardial infarction—Listen to your doctor! International Journal of Cardiology 130(1): e14-e16. |
Observational |
1999–2002 |
74 |
Fonarow, G. C., W. G. Stough, 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. |
Observational |
Unknown |
41,267 |
Methodology |
Outcome Measures |
Relevant Findings |
Mailed survey to patients discharged from university-affiliated hospital with diagnosis of acute coronary syndrome during a 3-year period |
Health status (SF-8, PCS-8, MCS-8, EQ-5D), cardiac function status (Duke Activity Status Index), symptom count, comorbidity index, patient-perceived cardiac disease severity, medication count and compliance, job satisfaction, current employment duration, patient demographics, acute coronary syndrome type |
Current employment is associated with higher work performance post acute coronary syndrome event. |
Discharge medication compared with outcome measures |
Rehospitalization or mortality within 1 year |
ACE inhibitors, spironolactone, and statins are associated with better outcomes in patients with heart failure who have been hospitalized. |
Questionnaire |
Physical, sociodemographic, psychological factors; return to work following myocardial infarction |
Controlling for other variables, only physicians’ advice was associated with return to work. |
Web-based registry; Pearson chi-square test and Wilcoxon test analyses |
Preserved systolic function if ejection fraction documented as ≥ 40% or qualitatively normal or mildly impaired; left ventricular systolic dysfunction if ejection fraction < 40% or moderate/ severe left ventricular dysfunction by qualitative assessment |
ACC/AHA performance measure application: adherence to measures more frequent with left ventricular systolic dysfunction; influence of pharmacologic therapy: preserved systolic function—no relationship with beta-blocker or ACE inhibitor, left ventricular systolic dysfunction and beta-blocker experienced significantly lower risk all-cause mortality at 60-to 90-day follow-up. |
Study |
Study Type |
Time Frame |
Sample Size |
Fonarow, G. C., W. T. Abraham, N. M. Albert, W. G. Stough, M. 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. |
Observational |
March 2003–December 2004 |
5,791 |
Fukuoka, Y., K. Dracup, M. Takeshima, N. Ishii, M. Makaya, L. Groah, and E. Kyriakidis. 2009. Effect of job strain and depressive symptoms upon returning to work after acute coronary syndrome. Social Science & Medicine 68(10):1875–1881. |
6-month prospective longitudinal study |
January 2004–March 2006 |
240 |
Geyer, S., K. Norozi, R. Buchhorn, and A. Wessel. 2009. Chances of 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. |
Observational |
April 2003–January 2004 |
314 |
Grady, K. L., P. M. Meyer, D. Dressler, C. White-Williams, A. 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. |
Observational |
August 1994–August 1999 |
40 |
Methodology |
Outcome Measures |
Relevant Findings |
Multivariable and propensity-adjusted analyses to assess process-outcome relationship for each performance measure |
Rehospitalization or mortality rates 60 to 90 days post-discharge |
Current heart failure performance measures have little relationship with patient mortality and hospitalization in 60–90 days post-discharge. |
Follow-up at 3 and 6 months; mailed written questionnaires; BDI-II; Job Content Questionnaire; Duke Activity Status Index |
Job strain/characteristics; Beck Depression Inventory II |
Even mild depressive symptoms were a strong predictor of delay or failure to return to work. |
Examined relationship between disease severity and employment status |
Classification by type of surgery (curative, reparative, palliative) as indicator of disease severity; classified by New York Heart Association system |
Likelihood of full-time employment decreases as disease severity increased. |
Quality of Life Index, Rating Question Form, Heart Failure Symptom Checklist, Sickness Impact Profile, Left Ventricular Assist Device (LVAD) Stressor Scale, Heart Transplant Stressor Scale, Jalowiec Coping Scale |
Quality of life at 3 months post-LVAD versus 3 months post-heart transplant |
Patients were significantly more satisfied with quality of life after heart transplantation compared with LVAD; mobility, self-care, physical ability, and overall functioning were more improved in transplant group |
Study |
Study Type |
Time Frame |
Sample Size |
Grady, K. L., D. C. Naftel, J. K. 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. |
Observational |
Unknown |
311 |
Holper, E. M., J. Blair, F. Selzer, K. M. Detre, A. K. Jacobs, D. O. Williams, H. Vlachos, R. L. Wilensky, P. Coady, D. P. Faxon, Registry Percutaneous Transluminal Coronary Angioplasty, and 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. |
Randomized controlled trial |
July 1997–February 1998; February 1999–July 1999; October 2001–March 2002 |
4,697 |
Incalzi, R. A., A. Corsonello, C. Pedone, F. Corica, P. Carbonin, and 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. |
Observational |
4 months, (unknown period) |
1,271 |
Methodology |
Outcome Measures |
Relevant Findings |
Sickness Impact Profile, Quality of Life Index, Heart Transplant Symptom Checklist, Jalowiec Coping Scale, Positive and Negative Affect Schedule-Expanded Form, Cardiac Depression Scale, Assessment of Problems with the Heart Transplant Regimen |
Differences in physical functional disability at 5 to 6 years post-transplant; clinical data collected from hospital records, clinic charts, and the Cardiac Transplant Research Database |
Physical functional disability was low at 5 to 6 years post-transplant; women had more overall physical functional disability; patients with comorbidities had more physical functional disability; and physical functional disability was related to activities of daily living. |
Telephone interview by trained nurse assessing symptoms, medication status, and coronary event |
Demographic; angiographic and lesion characteristics; patient-specific procedural data, outcomes (ejection fraction values) |
Patients with chronic heart failure were older and were more often women and African Americans. They 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 self-reported activities of daily living (ADLs) and instrumental activities of daily living (IADLs); surveys; questionnaires |
Functional status prehospital admission compared with assessments of postdischarge; comparing chronic obstructive pulmonary disease (COPD) and diabetes mellitus |
COPD is associated with a pattern of disability expressed by loss of select ADL/IADLs; with ADL/IADL cluster similar in two populations with different chronic conditions (e.g., chronic heart failure and diabetes mellitus); and crude lost IADL may not fully represent loss of personal independence. |
Study |
Study Type |
Time Frame |
Sample Size |
Jalowiec, A., K. L. Grady, and C. 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. |
Observational |
Unknown |
237 |
Kiessling, A., and P. Henriksson. 2005. Perceived cognitive function in coronary artery disease—An unrecognized predictor of unemployment. Quality of Life Research 14(6):1481–1488. |
Observational |
2 years (unknown period) |
169 |
Kuoppala, J., and A. Lamminpää. 2008. Rehabilitation and work ability: A systematic literature review. Journal of Rehabilitation Medicine 40(10):796–804. |
Review |
N/A |
N/A |
Lau-Walker, M. O., M. R. Cowie, and M. Roughton. 2009. Coronary 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. |
Observational |
3 years (unknown period) |
253 |
Massie, B. M., J. J. Nelson, M. A. Lukas, B. Greenberg, M. B. Fowler, 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. |
Observational |
1 year (unknown period) |
4,280 |
Methodology |
Outcome Measures |
Relevant Findings |
Sickness Impact Profile; paired t-tests; medical and demographic data on patient questionnaire |
Pre- and post-transplant functional scores from Sickness Impact Profile |
1-year post-transplant predictors of worse functional status included greater symptom distress, more stressors, neurologic problems, depression, female gender, older age, and lower left ventricular ejection fraction (worse function). |
Health-related quality of life questionnaires |
Gainful employment and return to work in patients with coronary artery disease |
Perceived cognitive function predicts both prevalence of unemployment and early 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 summary scores) |
Coronary artery disease 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 carvedilol, characteristics, carvedilol titration, and outcomes of patients according to left ventricular ejection fraction > 40% or < 40% |
Patient status and clinical events provided at baseline, end-titration and 6 and 12 months thereafter; clinical events defined as hospitalizations, unscheduled visits |
Patients with preserved ejection fraction were more likely to be older, female, and hypertensive; lower left ventricular ejection fraction was associated with worse functional class and more heart failure hospitalizations in the previous year. |
Study |
Study Type |
Time Frame |
Sample Size |
McBurney, C. R, K. A. Eagle, E. M. Kline-Rogers, J. V. Cooper, D. E. Smith, and S. R. Erickson. 2004. Work-related outcomes after a myocardial infarction. Pharmacotherapy 24(11):1515–1523. |
Observational |
7 months (unknown period) |
89 |
Mital, A., A. Desai, and A. Mital. 2004. Return to work after a coronary event. Journal of Cardiopulmonary Rehabilitation 24(6):365–373. |
Review |
N/A |
N/A |
Methodology |
Outcome Measures |
Relevant Findings |
Work-Performance Scale of the functional Status Questionnaire; health-related quality of life; Physical Component Summary (PCS-12) |
Return to work post-myocardial infarction |
Variables associated with not returning to work included past myocardial infarction, coronary artery bypass graft, heart failure, positive 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). |
Study |
Study Type |
Time Frame |
Sample Size |
O’Connor, C. M., D. J. Whellan, K. L. Lee, S. J. Keteyian, L. S. 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. |
Randomized controlled trial |
April 2003–February 2007 |
2,331 |
Paris, W., and C. White-Williams. 2005. Social adaptation after cardiothoracic transplantation: A review of the literature. Journal of Cardiovascular Nursing 20(Suppl 5): S67–S73. |
Review |
N/A |
N/A |
Petrucci, R. J., K. C. Truesdell, A. Carter, N. E. Goldstein, M. M. Russell, D. Dilkes, J. M. Fitzpatrick, 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. |
Observational |
January 1984–December 2002 (18 years) |
252 |
Phillips, L., T. Harrison, and P. Houck. 2005. Return to work and the person with heart failure. Heart & Lung 34(2):79–88. |
Review |
N/A |
N/A |
Methodology |
Outcome Measures |
Relevant Findings |
Multicenter randomized controlled trial; aerobic exercise training for patients with chronic heart failure |
Rehospitalization; all-cause mortality |
There were nonsignificant reductions in outcomes for primary group; authors 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 Stage III to IV symptomatic left ventricular ejection fraction < 20% requiring frequent hospitalization for worse heart failure and neuropsychological exam |
Memory, motor, and processing speed; neuropsychological exam |
Cognitive deficits are common in advanced heart failure and worsen with increasing severity of heart failure. |
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. |
Study |
Study Type |
Time Frame |
Sample Size |
Poston, R. S., R. Tran, M. Collins, M. Reynolds, I. Connerney, B. 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. |
Observational |
January 2005–June 2007 |
200 |
Reynolds, M. W., D. Frame, R. 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. |
Review |
N/A |
N/A |
Rollman, B. L., B. H. Belnap, M. S. LeMenager, S. Mazumdar, H. C. 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. |
Randomized controlled trial |
8 months (unknown period) |
450 |
Ruel, M., A. Kulik, B. K. Lam, 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. |
Observational |
1976–2002 |
500 |
Methodology |
Outcome Measures |
Relevant Findings |
Examine the efficacy of mini- versus standard-coronary artery bypass graft. Patients prescreened and interviewed 3- and 12-months post major adverse cardiac and cerebrovascular event (MACCE) |
Patient satisfaction; post-operative clinical data; demographics |
Mini-coronary artery bypass graft shortens patient recovery time, minimizes MACCE risk at 1 year, and shows superior quality and outcome metrics versus standard coronary artery bypass graft; there are 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 symptoms post-coronary artery bypass graft (PHQ-9) and 100 nondepressed patients, measured by SF-36 Mental Component Summary score |
Mood symptoms, cardiovascular morbidity, employment, health services use, and treatment costs |
To be determined. |
Primary valve replacement, either aortic or mitral |
Mortality, stroke, bleeding events, reoperation, heart failure, other prosthesis-related complications, quality of life |
Late outcomes of modern prosthetic valves in young adults remain suboptimal; bioprostheses deserve consideration in the aortic position, as mechanical. |
Study |
Study Type |
Time Frame |
Sample Size |
Vohra, R. S., P. A. Coughlin, and M. J. Gough. 2007. Occupational capacity following surgical revascularization for lower limb claudication. European Journal of Vascular and Endovascular Surgery 34(6):709–713. |
Observational |
February 2001–February 2005 |
139 |
White-Williams, C., A. Jalowiec, and K. Grady. 2005. Who returns to work after heart transplantation? Journal of Heart & Lung Transplantation 24(12):2255–2261. |
Observational |
Data collection ended in 1997 |
237 |
Methodology |
Outcome Measures |
Relevant Findings |
Questionnaires |
Employment status after procedure (lower limb revascularization) |
Two-thirds of potentially employable patients with 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 question form, heart transplant stressor scale, quality of life index, Sickness Impact Profile, Jalowiec Coping Scale, social support index, heart transplant symptom checklist, and chart review form; frequency distributions, chi-square, t-tests, and stepwise regression analysis |
Work history, quality-of-life outcomes collected at time of enrollment and 1-year post-transplant; functional status measured with the Sickness Impact Profile; Heart Transplant Stressor Scale developed for this study measures perceived stressful nature of issues related to HF and transplant; Quality of Life and Jalowiec Coping Scale measure patient life satisfaction and coping mechanisms |
81% of participants maintained employment status post-transplant. Those who did not work prior to transplant did not work post-transplant. Those who worked before surgery maintained employment after surgery. Twenty-one patients returned to work post-transplant, on average resuming work 4.8 months post-surgery. Ejection fraction did not differ significantly among those working and 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. |