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, return-to-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.
References
World Health Organization. Leading causes of death globally. The top 10 causes of death [Internet]. 2020 [cited 2024 Feb 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
American Heart Association. Heart Disease and Stroke Statistics - 2023 Update. [Internet]. 2023 [cited 2024 Feb 1]. Available from: https://professional.heart.org/en/science-news/heart-disease-and-stroke-statistics-2023-update.
United Nations Thailand, Ministry of Public Health. Economic burden of NCDs. Prevention and Control of Noncommunicable Disease in Thailand The case for investment. [Internet]. 2021 [cited 2024 Feb 1]. Available from: https://thailand.un.org/sites/default/files/2021-11/%E6%9C%80%E6%96%B0%EF%BC%BFTHAILAND_NCD%20IC%20REPORT_v06_231121.pdf.
Reibis R, Salzwedel A, Abreu A, et al. The importance of return to work: How to achieve optimal reintegration in ACS patients. Eur J Prev Cardiol 2019;26:1358-69.
Haskell WL, Brachfeld N, Bruce RA, et al. Task Force II: determination of occupational working capacity in patients with ischemic heart disease. JACC Adv 1989;14:1025-34.
Chawakitchareon V, Tultrairatana S. Return to work among patients hospitalized with acute coronary syndrome at Nopparat Rajathanee Hospital. J Med Health Sci 2021;28:1-16.
Sutton NR, Banerjee S, Cooper MM, et al. Coronary artery disease evaluation and management considerations for high risk occupations: commercial vehicle drivers and pilots. Circ Cardiovasc Interv 2021;14:e009950.
Driver and Vehicle Licensing Agency. Cardiovascular disorders. Assessing fitness to drive: a guide for medical professionals. Swansea: the Department for Transport; 2024. p.60-82.
Austroads and the NTC. Cardiovascular conditions. Assessing fitness to drive for commercial and private vehicle drivers. 6th ed. Sydney: Austroads; 2022. p.63-91.
Guerra PG, Simpson CS, Van Spall HG, et al. Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive. Can J Cardiol 2023:S0828-282X(23)01755-5.
National Fire Protection Association (NFPA). NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments. 2022 ed. Quincy: NFPA publication; 2022.
Parsons IT, Nicol ED, Holdsworth D, et al. Cardiovascular risk in high-hazard occupations: the role of occupational cardiology. Eur J Prev Cardiol 2022;29:702-13.
Jepson N, Rienks R, Smart D, et al. South Pacific Underwater Medicine Society guidelines for cardiovascular risk assessment of divers. Diving Hyperb Med 2020;50:273.
Oil and Gas UK. Determination of Risk for Specific Medical Conditions Cardiovascular system. In: Furnace G, Goodge A, Mckechnie R, editors. Medical Aspects of Fitness for Offshore Work: Guidelines for Examining Physicians. 6th ed. London: OIL and GAS UK; 2008. p.2-2-2-5.
The Medical Council of Thailand. Statistics of Thai medical specialists registered by the Medical Council of Thailand 1964-2023 [Internet]. 2023 [cited 2024 Feb 2]. Available from: https://www.tmc.or.th/pdf/stat-med-18-12-23-004.pdf
Natalie PH, Beth AB, Jeffrey LL, et al. ACOEM OEM core competencies: 2021. J Occup Environ Med 2021;e445-e461.
Coole C, Potgieter I, Nouri F, et al. Return-to-work outcomes and usefulness of actual fit notes received by employers. Fam Pract 2015;32:551-6.
Li J, Siegrist J. Occupational Risks of Recurrent Coronary Heart Disease. J Am Coll Cardiol; 2021. p. 1626-8.
Spencer EH. How to analyze Likert and other rating scale data. Curr Pharm Teach Learn 2015;7:836-50.
Herrmann SD, Willis EA, Ainsworth BE, et al. 2024 Adult Compendium of Physical Activities: A third update of the energy costs of human activities. J Sport Health Sci 2024;13:6-12.
Martin S. Determing Fitness to work at safety sensitive jobs. B C Med J 2010;52:48.
Ismail FKM, Zubairi AMB. Item Objective Congruence Analysis for Multidimensional Items Content Validation of a Reading Test in Sri Lankan University. Engl Lang Teach 2022;15:106-17.
Dhatsiwat C. The Delphi Technique of Researching. TJPA 2010;8:185-223.
Meesil N. Delphi Technique: Avoidance of misconception. Veridian E-Journal, Silpakorn University (Humanities, Social Sciences and arts) 2016;9:1256-67.
HA von der Gracht. Consensus measurement in Delphi studies Review and implications for future quality assurance. Technol Forecast Soc Change 2012;79:1525-36.
Guettler N, Rajappan K, D´ Arcy JL, et al. Electrophysiologic assessment of aircrew and other high-hazard employees: This third article in the occupational cardiology series focusses on the assessment of arrhythmias in high-hazard employees and how, not all arrhythmias prevent employment. Eur Heart J 2019;40:2560-3.
Members WC, Virani SS, Newby LK, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. JACC Adv 2023;82:833-955.
Byrne RA, Rossello X, Coughlan J, et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 2023;44:3720-826.
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC Adv 2022;79:e263-e421.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2021;42:3599-726.
McDonagh TA, Metra M, Adamo M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2023;44:3627-39.
Zeppenfeld K, Tfelt-Hansen J, De Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2022;43:3997-4126.
Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC guidelines for the management of patients with supraventricular tachycardia the task force for the management of patients with supraventricular tachycardia of the European society of Cardiology (ESC) developed in collaboration with the association for European paediatric and congenital Cardiology (AEPC). Eur Heart J 2020;41:655-720.
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373-498.
Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024;149:e1-e156.
The Heart Association of Thailand Under the Royal Patronage of H.M. the King. Thai Acute Coronary Syndromes Guidelines 2020. 1st ed. Bangkok: nextstep; 2020.
The Heart Association of Thailand Under the Royal Patronage of H.M. the King. Thai Chronic Coronary Syndromes Guidelines 2021. 1st ed. Bangkok: nextstep; 2021.
The Heart Association of Thailand Under the Royal Patronage of H.M. the King. Heart Failure Council of Thailand (HFCT) 2019 Heart Failure Guideline. 1st ed. Bangkok: nextstep; 2019.
Sangareddi V, Chockalingam A, Gnanavelu G, et al. Canadian Cardiovascular Society classification of effort angina: an angiographic correlation. Coron Artery Dis 2004;15:111-4.
American Heart Association. Angina (Chest pain) [Internet]. 2024 [cited 2024 Feb 3]. Available from: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain.
Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, et al. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Europace 2014;16:1655-73.
Seger JJ. Cardiac Arrhythmias: Syncope Evaluation and Management. Tex Heart Inst J 2005;32:204.
Ashley EA, Niebauer J. Arrhythmia. In: Ashley EA, Niebauer J, editors. Cardiology explained. 1st ed. London: Remedica; 2004. p.111-44.
Mathew RP, Alexander T, Patel V, et al. Chest radiographs of cardiac devices (Part 1): Cardiovascular implantable electronic devices, cardiac valve prostheses and Amplatzer occluder devices. SA J Radiol 2019;23:1-13.
Sadeghi M, Rahiminam H, Amerizadeh A, et al. Prevalence of return to work in cardiovascular patients after cardiac rehabilitation: a systematic review and meta-analysis. Curr Probl Cardiol 2022;47:100876.
Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013;128:873-934.
Rubáčková Popelová J, Tomková M, Tomek J, et al. Long-term survival of adult patients with atrial septal defect with regards to defect closure and pulmonary hypertension. Front Cardiovasc Med 2022;9:1-8.
Chappel SE, Verswijveren SJ, Aisbett B, et al. Nurses’ occupational physical activity levels: A systematic review. Int J Nurs Stud 2017;73:52-62.
Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC). Eur Heart J 2021;42:17-96.
Han J, Lalario A, Merro E, et al. Sudden cardiac death in athletes: facts and fallacies. J Cardiovasc Dev Dis 2023;10:68.
Holtermann A, Schnohr P, Nordestgaard BG, et al. The physical activity paradox in cardiovascular disease and all-cause mortality: the contemporary Copenhagen General Population Study with 104 046 adults. Eur Heart J 2021;42:1499-511.
Rios DM, Devens GL, Louzada LA, et al. Correlation between the Six-Minute Walk Test and Subjective Functional Class in Patients with Heart Failure. World J Cardiovasc Dis 2023;13:205-13.
Blacher M, Zimerman A, Engster PH, et al. Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II. Heart 2021;107:1487-92.
Alsharef A, Albert A, Awolusi I, et al. Severe injuries among construction workers: Insights from OSHA’s new severe injury reporting program. Saf Sci 2023;163:1-17.
Weber SA, McGahan MM, Kaufmann C, et al. Suspension trauma: a clinical review. Cureus 2020;12:1-6.
Rienks R, Holdsworth D, Davos CH, et al. Cardiopulmonary assessment prior to returning to high-hazard occupations post-symptomatic COVID-19 infection: a position statement of the Aviation and Occupational Cardiology Task Force of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022;29:1724-30.
Connecticut Department of Labor Wage & Workplace Standards Division. List of Occupations Designated As High-Risk Or Safety-Sensitive by the Labor Commissioner of the State of Connecticut [Internet]. 2019 [cited 2024 Feb 3]. Available from: https://portal.ct.gov/dol/-/media/DOL/2022-New-Design-System/Divisions/wage-and-workplace-standards/HRSSOccupationsList.pdf.
Compendium of Physical Activities. Compendium of Physical Activities: Quantifying Physical Activity Energy Expenditure [Internet]. 2024 [cited 2024 Feb 4]. Available from: https://pacompendium.com/adult-compendium/
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