Return to work after uncomplicated myocardial infarction: a trial of practice guidelines in the community.
OBJECTIVE
To evaluate the effectiveness of practice guidelines for return to work after acute myocardial infarction when disseminated from a university-based setting to a practice-based setting.


METHODS
Randomized clinical trial.


METHODS
A total of 187 patients with uncomplicated acute myocardial infarction.


METHODS
Patients were randomly assigned to the intervention (n = 95) or to usual care (n = 92). The intervention consisted of a treadmill test, a counseling session based on the test results, and a consultation letter from a cardiologist to the primary care physician. Individualized recommendations for the timing of return to work, contained in the consultation letter, were based on the patient's risk for recurrent cardiac events.


METHODS
Questionnaire, chart review, and a phone interview documented the timing of return to work and the rates of cardiac death, coronary angioplasty, coronary artery surgery, and recurrent myocardial infarction.


RESULTS
Median intervals between acute myocardial infarction and return to work were similar in both groups (intervention, 54 days; usual care, 67 days; P greater than 0.2). Among patients without myocardial ischemia, however, the interval was shorter in the intervention group than in the usual care group (38 days compared with 65 days, respectively, P = 0.008). Among patients with myocardial ischemia, intervals were similar in both groups (80 days compared with 76 days, respectively, P greater than 0.2).


CONCLUSIONS
Practice guidelines developed in a university-based setting were not as successful in hastening return to work after uncomplicated acute myocardial infarction when tested in a practice-based setting. Physicians' reluctance to follow guidelines for patients with myocardial ischemia reflected their concern with prognosis even though medical outcome was good.
Pilote
L
L
Stanford University School of Medicine, California.
Thomas
R J
RJ
Dennis
C
C
Goins
P
P
Houston-Miller
N
N
Kraemer
H
H
Leong
C
C
Berger
W E
WE
Lew
H
H
Heller
R S
RS
D000328:Adult; D003327:Coronary Disease / Q000175:diagnosis; D005080:Exercise Test; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000534:rehabilitation*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012008:Recurrence; D012306:Risk; D013997:Time Factors; D014938:Work Capacity Evaluation