DEAR DOCTOR K:
I am 59 years old. I recently came home after being hospitalized for five days for a mild heart attack. I feel great — but my doctor says he doesn’t want me to go back to work for another six weeks, even though my job mostly involves sitting at my desk. I like to stay busy and feel ready to return to the office. Please advise.
The treatment of heart attacks has come a long way in the past 30 years. Doctors can now open blocked coronary arteries with angioplasty balloons and stents or “clot-busting” drugs. We can use stress tests and echocardiograms to classify patients as low-, intermediate- or high-risk when they are discharged from the hospital. And patients go home with medications that reduce the likelihood of another heart attack.
With today’s treatments, people leave the hospital much sooner. Only a couple of decades ago, the typical heart attack patient spent weeks in the hospital, much of it on strict bed rest.
In most hospitals today, patients who have a heart attack without additional complications are out of bed in a day. They’re walking in a day or two, on a treadmill for a low-level stress test in four or five days — and then home.
But, as in your case, many patients are advised to stay 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 normal activities, including work, either two or six weeks after their heart attacks. All the patients had been classified as low risk before leaving the hospital, and all received standard medical care, as you did.
Over the next six months, the patients did well. The patients who returned to work earlier did not have a greater number of heart problems — repeat heart attacks, heart failure or deaths. So this one study suggests that people at low risk after a heart attack may be able to return to work sooner than six weeks.
While training in internal medicine, I cared for a patient with a heart attack. His cardiologist had ordered that he lie flat all the time, even to pass his urine or have a bowel movement. After five days, he told me this was driving him crazy. He asked if he could just sit up and dangle his legs off the side of the bed, and I agreed. Nothing bad happened — to him.
However, when the cardiologist found out, he hit the ceiling. To make matters worse, he was one of the most famous and accomplished cardiologists of the 20th century — and I was not. But on this matter, many studies since then have shown that he was wrong.
My take-home lessons from this experience: In the absence of evidence, the judgment of even the finest doctors can be wrong. There is no substitute for actually studying what is the best way to treat a medical problem. So ask your doctor if he would reconsider his advice about when to return to work.