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Effects of Coronary Angioplasty, Coronary Bypass Surgery, and Medical Therapy on Employment in Patients with Coronary Artery Disease: A Prospective Comparison Study

Daniel B. Mark, MD, MPH; Lai Choi Lam, MS; Kerry L. Lee, PhD; Robert H. Jones, MD; David B. Pryor, MD; Richard S. Stack, MD; Redford B. Williams, MD; Nancy E. Clapp-Channing, MPH; Robert M. Califf, MD; and Mark A. Hlatky, MD
[+] Article, Author, and Disclosure Information

From Duke University Medical Center, Durham, North Carolina. Stanford University School of Medicine, Stanford, California. Requests for Reprints: Daniel B. Mark, MD, MPH, P.O. Box 3485, Duke University Medical Center, Durham, NC 27710. Acknowledgments: The authors thank Ms. Susan Blackwell, Ms. Diane Cooper, Ms. Carolyn Lumpkins, Ms. Dorothy Brown, Mr. Charlie Moore, and Ms. Lori Baysden for providing technical assistance. Grant Support: By grants HL-36587, HL-45702 and HL-17670 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland; grants HS-05635 and HS-06503 from the Agency for Health Care Policy and Research, Rockville, Maryland; and a grant from the Robert Wood Johnson Foundation, Princeton, New Jersey.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(2):111-117. doi:10.7326/0003-4819-120-2-199401150-00003
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Objective: To compare return-to-work rates after coronary angioplasty, coronary bypass surgery, and medical therapy in patients with coronary disease.

Design: Prospective cohort study.

Setting: Tertiary care referral center.

Patients: Between March 1986 and June 1990, we enrolled 1252 patients who were younger than 65 years, who had not had previous coronary revascularization, and who were employed. All patients were followed for 1 year.

Main Outcome Measure: One-year employment status.

Results: After 1 year, 84% of patients who had coronary angioplasty were still working compared with 79% of patients who had bypass surgery and with 76% of patients who received medicine. After adjusting for the more favorable baseline characteristics of patients who had angioplasty (less severe coronary artery disease, better left ventricular function, and less functional impairment), however, no significant differences were noted in 1-year employment rates among the three groups. These adjusted 1-year return-to-work rates were 84% for angioplasty, 80% for surgery, and 79% for medicine (P > 0.05). In a random subset of 72 patients, 23 patients who had angioplasty returned to work after a median of 18 days (mean, 27 days) compared with 54 days (mean, 67 days) for 24 patients having bypass surgery and with 14 days (mean, 45 days) for 25 patients receiving medicine (P = 0.002).

Conclusions: Patients who had coronary angioplasty were able to return to work earlier than those who had bypass surgery, but by 1 year no significant difference was noted in employment rates. Neither revascularization strategy improved employment rates when compared with initial treatment using medical therapy.


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Figure 1.
Kaplan-Meier plot of time to initial return to work by treatment group for 72 patients.

The x-axis shows days from diagnostic cardiac catheterization until return to work. The y-axis shows the proportion of patients returning to work at each time interval. The 0.5 point indicates the median value; the area under each curve indicates the mean value for that group: angioplasty, 27 days; bypass surgery, 67 days; and medicine, 45 days. CABG = coronary artery bypass graft; PTCA = percutaneous transluminal coronary angioplasty.

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Figure 2.
Kaplan-Meier plot of the dollar value of the initial time lost from work displayed inFigure 1by treatment group.

The average weekly income for all 72 patients was used in the calculations. The x-axis shows the dollar value of the initial time lost from work (weekly income multiplied by the number of weeks lost from work). The y-axis shows the proportion of patients at or above each x-axis value for each treatment group. The 0.5 point indicates the median value; the area under each curve indicates the mean value. CABG = coronary artery bypass graft; PTCA = percutaneous transluminal coronary angioplasty.

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