Factors influencing the return to work of men with congestive heart failure

The difference between these groups, as indicated in this study of men with congestive heart failure, seems to be related to the interaction of social and psychological factors with physiological limitations imposed by the biologic disease process.

Abstract

What then is the composite picture of the man who returns to work? He has heart disease, but usually does not have severe congestive failure. His cardiac compensation may improve to the degree where he can discontinue digitalis or its derivatives. He has been employed most of the past 5 years; he has a high school education or better; and he has a physician that he sees regularly (but the type of physician does not seem to matter). He is a 'white collar worker' or if a 'blue collar worker' he usually belongs to a union. He is not known to welfare agencies. He is optimistic, and his doctor agrees with his optimism. He resumes off-job activities and also resumes sexual activities. His family, according to him, does not reject him or behave in an over-protective manner. On the other hand, the man who does not return to work has a more limited cardiac reserve. He is 'inferior' with regard to education. He does not belong to a union. He is frequently 'laid off' after the onset of his congestive failure, or feels that he is. He frequently has other health and welfare problems, and is known to social and welfare agencies. His outlook is pessimistic; he has few outside activities; he usually does not resume or engage in sexual activities after the onset of his heart failure. He may admit that he is afraid to return to work. He feels that his family rejects him or is overly protective. Much of the information presented in previous paragraphs as a composite description of these two types of men might be used to describe any group of patients with chronic disease. Some are 'good patients' who are highly motivated. They follow physician's advice, they make a great effort to take medication as directed and stay upon other therapeutic regimes. There are others who are destined to live out the natural history of their disease in limbo. The difference between these groups, as indicated in this study of men with congestive heart failure, seems to be related to the interaction of social and psychological factors with physiological limitations imposed by the biologic disease process. The current methods of 'managing' these poorly motivated, apathetic patients seem doomed to failure. The provision of effective long-term supportive care for this type of patient may depend upon the development of new and imaginative methods of delivering medical care.