Returning to Work
A Forgotten Aspect of Rehabilitation for Heart Failure
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Article, see p 999
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
World Health Organization*
For the past 60 years, the World Health Organization has defined health in this way. With advances in therapy, heart failure (HF) can now be considered to be a chronic condition with which many individuals will live for some, if not many, years. Reducing morbidity and improving quality of life are important therapeutic aims.1,2 Traditionally, returning individuals to a more optimal state of health was the province of cardiac rehabilitation programs, initially focused on patients after myocardial infarction or coronary artery bypass surgery, but now opened more widely to those after any coronary intervention and, at last, to those with HF. At the core of cardiac rehabilitation programs is the desire to return individuals to their optimal physical, mental, medical, psychological, social, emotional, sexual, vocational, and economic status.3
When reading HF clinical guidelines, one could be forgiven for thinking that no patient with HF was in employment, or would seek employment. In the United States, an American Heart Association Presidential Advisory was issued in 2011 calling for a multipronged effort to increase the low referral rates to cardiac rehabilitation/secondary prevention programs after a cardiac event.4 This advisory specifically mentioned vocational counseling. The most recent American Heart Association/American College of Cardiology HF guideline awards a class IIa level recommendation (it is reasonable to offer) for rehabilitation,1 although return to work is not listed as a potential benefit. The 2016 HF guidelines from the European Society of Cardiology do not discuss occupational issues, although the recommendation is made for a “seamless system of multidisciplinary care that embraces both the community and hospital” and mention is made of the …