Despite its success in alleviating angina pectoris, coronary artery surgery (CAS) does not enhance employment status. This project is designed to test the efficacy of an intervention, the Occupational Work Evaluation (OWE), in facilitating a safe, early return to work after CAS. The OWE is directed toward improving the confidence of physicians and patients that patients classified as low risk can safely resume their occupational tasks significantly earlier than the current standard. The OWE has two parts: 1) a treadmill exercise test which demonstrates patients' capacity for occupational work followed by a counseling session with patient and spouse regarding the results of this test and 2) a written recommendation to the physician that the patient return to work 28 - 56 days after CAS, depending on the results of the test. The proposed trial is based on experience in a similar trial in which post-MI patients undergoing the OWE returned to work 24 days sooner than those receiving usual care (median of 51 vs. 75 days). The 500 previously employed men and women aged 60 or less who are medically eligible to undergo symptom-limited treadmill testing 28-35 days after CAS will be randomized to the Occupational Work Evaluation or to usual care. This is the first trial to evaluate an intervention our reducing occupational disability after CAS. The primary outcome of the proposed trial is the interval between CAS and return to full-time work. Pilot studies of patients undergoing CAS in the same 4 participating hospitals indicate that the present interval of approximately 88 days can be shortened to 55 or fewer days. A secondary outcome is the cost-benefit of the intervention. In the previous trial the 3 week earlier return to work after acute MI equated to $2100 in additional salary and $500 in lesser costs for diagnostic tests, rehospitalization and medical and surgical therapy. Incremental costs for the OWE approximated $250. .A tertiary outcome is the quality of life after CAS as assessed by standardized survey instruments. This multi-hospital project, coordinated by a single academic research group aided by an advanced system of microcomputers, represents a more cost-effective research design. Personnel, equipment and facilities required for OWE currently exist within community hospitals. The results of this trial will encourage the more effective use of these resources in diminishing occupational disability after CAS.
