Q: My 59-year-old husband just came home after being hospitalized for a mild heart attack. He was only in the hospital for five days, and he feels great, though he does have to take three prescription medicines plus aspirin. I'm writing because my husband's doctor doesn't want him to go back to work for another six weeks, even though his job doesn't involve any lifting. I think the stress of staying home would be worse than going to work. Any advice?
A: The treatment of heart attacks has come a long, long way in the past 30 years. Technology is responsible for many improvements; the outstanding change is that doctors can now open blocked coronary arteries with angioplasty balloons and stents or "clot-busting" drugs. Doctors have also learned how to use stress tests and echocardiograms to classify patients into low-, intermediate-, or high-risk groups at the time of hospital discharge. And most patients go home with a beta blocker, an ACE inhibitor, a statin drug, and low-dose aspirin to reduce the likelihood of another heart attack. Comprehensive cardiac rehabilitation programs can also help.
Although this progress entails additional tests and treatments, it also allows a much faster recovery and return to activity. Not too very long ago, the typical person who had a heart attack spent weeks in the hospital, much of it on strict bed rest. And I do mean strict; when I was an intern, patients with new heart attacks were not even allowed to feed or shave themselves.
In most hospitals today, patients with uncomplicated heart attacks are out of bed in a day, walking in a day or two, on a treadmill for a low-level stress test in four or five days — and then home. But many patients are still kept away from work for four to six weeks. That's a big improvement from the eight- to 12-week prohibitions of the past — but is it really necessary?
To find out, doctors in Australia randomly assigned 142 patients to return to full normal activities, including work, at either two or six weeks after their heart attacks; 87 percent were men. All the patients had been classified as low risk before hospital discharge, and all received standard medical care, including preventive medications like your husband's. Over the next six months, the patients did well; one patient in the early work group and three in the conventional return-to-work group suffered second heart attacks, but there were no deaths or episodes of heart failure in either group.
Medical care must always be individualized, especially in the case of serious illnesses like heart attacks. Your husband's doctor may be going by the book, but the latest chapter suggests an early return to work is OK for patients who are doing well. Discuss the situation fully at your next office visit; chances are your husband and his doctors will be on the same page.
Dr. Harvey B. Simon is editor of Harvard Men's Health Watch.
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