Document Detail

Return to work after uncomplicated myocardial infarction: a trial of practice guidelines in the community.
MedLine Citation:
PMID:  1503329     Owner:  NLM     Status:  MEDLINE    
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. DESIGN: Randomized clinical trial. PATIENTS: A total of 187 patients with uncomplicated acute myocardial infarction. INTERVENTION: 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. MEASUREMENTS: 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). CONCLUSION: 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.
L Pilote; R J Thomas; C Dennis; P Goins; N Houston-Miller; H Kraemer; C Leong; W E Berger; H Lew; R S Heller
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Annals of internal medicine     Volume:  117     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1992 Sep 
Date Detail:
Created Date:  1992-09-16     Completed Date:  1992-09-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  383-9     Citation Subset:  AIM; IM    
Stanford University School of Medicine, California.
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MeSH Terms
Coronary Disease / diagnosis
Exercise Test
Health Maintenance Organizations
Inservice Training
Middle Aged
Myocardial Infarction / rehabilitation*
Practice Guidelines as Topic
Primary Health Care
Time Factors
Work Capacity Evaluation*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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