Development of a medical assessment guide for cardiac disease patients when returning to work using a modified Delphi technique
Keywords:
cardiac disease, occupational cardiology, return-to-workAbstract
When considering the return-to-work (RTW) of patients with cardiac diseases, it is essential to take into account the intricacies of their conditions and workplace safety. While a few evidence-based standard guidelines exist in developing countries, they are not well-established. This study aims to develop a medical assessment guide for physicians involved in RTW evaluation. A Modified Delphi technique was utilized to gather the necessary components for the medical evaluation of workers with cardiac diseases returning to work. The process involved constructing a questionnaire and recruiting experts, followed by expert agreement on the completed questionnaire regarding the essential components of the RTW guide. Subsequently, a second round of expert agreement was conducted to address additional information and questions. Consensus was reached on the essential components of the RTW guide. After two rounds of agreement, the necessary components included history taking, physical examination, cardiac investigation, management information, and evaluation of metabolic equivalents (METs) for the patient and their physical work demands. For instance, in the case of non-strenuous work, RTW can be conducted without a cardiorespiratory fitness (CRF) test to calculate METs in patients with ischemic heart disease, post-open-heart surgery, and some types of cardiac arrhythmia, though there was no consensus on heart failure patients in non-strenuous work. For patients engaged in safety-sensitive work, a multidisciplinary team (MDT) assessment was suggested for those with post-open-heart surgery, cardiac arrhythmia, or heart failure. In conclusion, returnto-work evaluation could be conducted by predicting non-exercise cardiorespiratory fitness based on the New York Heart Association classification for non-strenuous work, except in patients with heart failure. MDT assessment is recommended for patients involved in safety-sensitive work.
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