Page 179 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP6.2 Managing Service Demands 10:45 Room 221

Early Return-to-work Programme for Young Cardiac Patients: The Preliminary Results
Chu WY 1, Yu PK1, Cheng WC 1, Chan NY 2
1Occupational Therapy Department, 2Department of Medical and Geriatrics, Princess Margaret Hospital, Hong Kong

Introduction

Myocardial infarction (MI) is increasingly common in young population. However, the process of return to work for post-MI
patients is not well understood. Potential risks for safe return to work are expected in some patients due to impaired cardiac
function, physical capacity or psychosocial function. Better strategies are needed to facilitate them to overcome barriers in
resuming work.

Objectives

A pilot programme, collaborated by Cardiac Team and Occupational Therapy Department of Princess Margaret Hospital, was
implemented to facilitate the process of return to work through a comprehensive work rehabilitation programme for post-MI
patients.

Methodology Tuesday, 19 May

Target cases were post-MI patients of working age. A pre-work screening was carried out to identify medical, occupational
and psychosocial barriers that might hinder the process of return to work. Reperfusion procedure by direct percutaneous
coronary intervention (PCI) would be performed to improve medical factors. Echocardiogram (ECHO) and stress test would
be conducted for risk stratification. Early work capacity evaluation (WCE) and training would be performed under enhanced
monitoring procedure.

Results

11 male and one female patients (mean age 54.2 +/- 5.8) were recruited from June 2014 to February 2015. Their diagnoses
included seven cases of ST segment elevation myocardial infarction (STEMI), two cases of non-ST segment elevation
myocardial infarction (NSTEMI), two cases of unstable angina, and one case of STEMI with sudden cardiac death and all
with PCI done. Post-PCI ECHO results were satisfactory except one patient. The stress test results attained mean metabolic
equivalent (METS) of 8.4 +/- 1.5 with target heart rate at 82.2 +/- 10.9%. WCE revealed 66.6% high physical demands
characteristics (PDC) and 33.3% medium PDC at work. The overall results performed as 66.6% matched, 16.7% marginally-
matched and 16.7% unmatched with previous work demands. 33.3% of the patients were arranged for work training. At the
time of programme review, 11 patients were advised to resume same job directly or with some modifications and one patient
had defaulted the programme. The mean total scores of hospital anxiety depression scale (HADS) were stable (6.72 +/- 5.23
to 6.36 +/- 4.2, n=11). For SF36, despite not reaching significant level, improving trends were noted in the role-physical (34.09
+/- 43.67 to 54.54 +/- 38.43) and the role-emotional domains (54.54 +/- 42.87 to 66.64 +/- 39.47). One patient displayed
persistent distress in psychological functions who showed unmatched work performance, had defaulted the programme. The
mean time for patients to resume work (n=11) after PCI and hospital discharge was 21.1 +/- 15.9 days and 17.1 +/- 13.8 days
respectively.

The preliminary results suggested that safe and early return to work for post-MI patients could be achieved by systematic
procedure for improving medical factors, reducing risks and enhancing work capacity. For young cardiac patients, the ability
to return to work not only potentially improve subjective well-being by fulfilling the physical and psychological role demands,
the socio-economic benefits were also promising in easing the overall disease burden by improving productivity.

HOSPITAL AUTHORITY CONVENTION 2015

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