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Results of a Randomized Trial

Charles Dennis, MD; Nancy Houston-Miller, RN; Rick G. Schwartz, PhD; David K. Ahn, PhD; Helena C. Kraemer, PhD; Denis Gossard, MD; Martin Juneau, MD; C. Barr Taylor, MD; Robert F. DeBusk, MD

JAMA. 1988;260(2):214-220.

Abstract
To determine if an occupational work evaluation could shorten the time to return to work, 201 employed men aged 49 ±7 years who were recovering from uncomplicated myocardial infarction were randomized to usual care (n = 102) or to an occupational work evaluation (n = 99). The occupational work evaluation consisted of a symptom-limited treadmill test performed 23 ±3 days after myocardial infarction and a formal recommendation to the patient and primary physician that the patient return to work within the next two weeks. The groups did not differ in age, medical status, comorbid disease, occupation type, or years on the job. At six months, 92% of patients receiving the intervention and 88% of patients receiving usual care were working either full- or part-time. Return to fulltime work occurred at a median of 51 days in patients receiving the intervention and 75 days in patients receiving usual care. This 32% reduction in the convalescence period was associated with $2102 of additional earned salary per intervention patient in the six months after myocardial infarction. One or more recurrent cardiac events occurred in 14 intervention patients (one death, one nonfatal myocardial infarction, three angioplasties, and nine coronary surgeries) and in 13 usual-care patients (two deaths, three nonfatal myocardial infarctions, six angioplasties, and seven coronary surgeries) in the six months after myocardial infarction. The early return to work of low-risk patients based on an occupational work evaluation is associated with important economic benefits.

(JAMA 1988;260:214-220)

Author Affiliations
From the Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif. Drs Gossard and Juneau are currently affiliated with the Montreal Heart Institute, Montreal.

Footnotes
Presented at the Annual Scientific Sessions of the American Heart Association, Dallas, Nov 12,1986.

Reprint requests to Stanford Cardiac Rehabilitation Program, 730 Welch Rd, Suite B, Palo Alto, CA 94304 (Dr Dennis).

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