Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Heart Failure, Congestive


Related Terms

  • Cardiac Decompensation
  • Cardiac Insufficiency
  • CHF
  • Compensated Heart Failure
  • Congestive Heart Failure
  • Decompensated Heart Failure
  • Heart Failure
  • Left Ventricular Failure
  • Ventricular Failure

Differential Diagnosis

Specialists

  • Cardiologist, Cardiovascular Physician
  • Cardiovascular Surgeon
  • Critical Care Internist

Comorbid Conditions

  • Anemia
  • Diabetes mellitus
  • Hyperlipidemia
  • Hypertension
  • Hyperthyroidism
  • Myocardial infarction
  • Obesity
  • Renal failure
  • Thyrotoxicosis

Factors Influencing Duration

Factors that might influence the length of disability include cardiac function, severity of heart failure, underlying cause of the condition, type of treatment, individual's response to treatment, presence of complications, and presence of concomitant illness. Surgical treatment may increase duration.

The physical demands of the job will be a major determining factor in the expected length of disability. The availability of lighter or part-time work on either a temporary or permanent basis may help to reduce duration. The individual's willingness to address correctable risk factors (i.e., smoking, sedentary lifestyle, obesity) may be a fundamental determinant of the length of disability. A cardiac rehabilitation program may facilitate recovery and shorten the period of disability. Severe mental stress or exertion may trigger increased symptoms and complications.

Medical Codes

ICD-9-CM:
428.0 - Heart Failure, Congestive
428.1 - Heart Failure, Left
428.9 - Heart Failure, Unspecified; Cardiac Failure NOS; Heart Failure NOS; Myocardial Failure NOS; Weak Heart

Overview

Congestive heart failure (CHF) is a disorder in which the heart is unable to pump an adequate amount of blood to meet the metabolic demands of the body at rest or during exercise. The amount of blood coming out of the heart is decreased, which leads to inadequate blood flow and inadequate delivery of oxygen to organs and tissues throughout the body (decreased tissue perfusion). In response to decreased tissue perfusion, the body activates certain normal, compensatory mechanisms as if a hemorrhage had occurred to cause the inadequate perfusion. However, these complex mechanisms (e.g., release of norepinephrine, dilation of the cardiac chambers, or activation of the sympathetic nervous system) may result in increased pressure and congestion in the vessels (hence the term "congestive heart failure"). Eventually, as the compensatory mechanisms are overwhelmed, the heart begins to fail, resulting in circulatory failure and increased morbidity and death.

Valvular, congenital, metabolic, and inflammatory diseases, as well as underlying coronary artery disease or functional disorders of the heart muscle (cardiomyopathies), can result in heart failure. Uncontrolled hypertension, hyperthyroidism, and anemia can also cause CHF. Heart failure can be acute or chronic. Acute heart failure can have rapid or somewhat gradual onset of symptoms resulting from a sudden increase in filling pressures and development of pulmonary edema. Acute heart failure requires hospitalization and emergency treatment.

CHF is categorized in a number of different ways. The New York Heart Association (NYHA) classification is often used by physicians to assess or "stage" heart failure. Four classes are described. In class I, individuals have no physical limitations (no fatigue, dyspnea, or palpitation) but have known heart disease; class II individuals are limited in their physical activity (presence of fatigue, palpitations, dyspnea, or angina with activity); class III individuals are comfortable at rest, but minimal activity produces fatigue, dyspnea, palpitations, or angina; and class IV individuals have symptoms at rest, and increased symptoms with even the least physical activity (Hunt).

Another term to describe the condition is left or right ventricular failure, which refers to failure of the left or right lower pumping chambers (ventricles) of the heart. Left ventricular failure typically results from high blood pressure (hypertension), decreased blood flow and oxygen delivery to the heart muscle (ischemic heart disease), or diseases of the valves within the left heart (aortic or mitral valvular disease). Fluid and blood may accumulate in the lungs, producing shortness of breath. Right ventricular failure may develop independently, or more commonly it may follow or result from the development of left ventricular failure. Causes of right ventricular failure that develop independently of left ventricular failure include lung diseases (chronic obstructive pulmonary disease, or COPD), inflammation of the tissue that surrounds the heart (constrictive pericarditis), or diseases of the valves within the right heart (tricuspid or pulmonic valvular disease). Fluid and blood may accumulate in the abdomen, legs, and feet, producing swelling (edema).

Incidence and Prevalence: The number of individuals affected by CHF is about 5.7 million, and it is the primary cause of hospitalization among individuals over age 65, affecting 10 senior adults in 1,000 annually (Roger). About 670,000 individuals are newly diagnosed with CHF each year (Roger). Heart failure affects 2% of the population (Roger). Hospitalization for CHF has remained largely unchanged over the past 10 years with 975,000 discharges in 1999 and 1,094,000 in 2009 (Roger). Although individuals of all ages may develop CHF, the incidence of CHF increases significantly with age. The lifetime risk of developing CHF after age 40 is 1 in 5. This risk remains the same after age 70. CHF affects over 10% of people aged 80 years or older (Roger). Men and women are affected equally, but women develop CHF later in life and survive longer than men with heart failure, accounting for age-adjusted incidence (Roger). The incidence of CHF is double in obese individuals (Roger).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Clinical risk factors for development of CHF include defects in the septum that separates the left and right ventricles (ventricular septal defect), any disease that affects the heart muscle (cardiomyopathy), coronary artery disease (CAD), decreased oxygen-carrying capacity of the blood (anemia), overactive thyroid gland disease (hyperthyroidism, thyrotoxicosis), diabetes, pregnancy, prolonged fever, blood clots in the lungs (pulmonary embolism), rheumatic fever, and abnormal heartbeat (arrhythmia). About 85% of individuals with coronary artery disease go on to develop CHF, and individuals with type 2 diabetes mellitus are 2 to 5 times more likely to develop CHF (Fonarow).

Tobacco smoking, obesity, and a sedentary lifestyle increase the risk of congestive heart failure. Hispanics, black Americans, and Native Americans experience a higher incidence and prevalence of CHF, secondary to increasing incidence and prevalence of hypertension and diabetes in those populations. A lack of preventive health care services for those groups exacerbates the problem (Roger).

Recent immigrants from Russia and the former Soviet republics to the US also have a higher incidence and prevalence of heart failure.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with left ventricular heart failure may complain of shortness of breath (dyspnea), dry hacking cough, difficulty in breathing when lying down (orthopnea), and awakening at night acutely short of breath (paroxysmal nocturnal dyspnea). Fatigue and activity intolerance, weakness, dizziness, and brief fainting spells (syncope) may also be reported. Individuals with right ventricular failure may report swelling (edema) in the feet and legs, pain in the upper right part of the abdomen due to edema in the liver, nausea, loss of appetite (anorexia), and excessive urination at night (nocturia). Individuals with both right and left ventricular failure (bi-ventricular failure) may report all the symptoms listed above. Individuals with CHF may report a history of diabetes or chronic alcohol abuse. A family history of heart failure may be reported. A personal history of prior heart attack (myocardial infarction), high blood pressure, arrhythmia, kidney problems, lung disease, or anemia may also be reported. History also includes a review of current medications.

Physical exam: In individuals with left ventricular failure, the use of a stethoscope (auscultation) might reveal popping sounds in the chest during breathing (pulmonary "rales" or "crackles") indicating congestion and a degree of pulmonary edema. In individuals with right ventricular failure, the veins in the neck may be enlarged (jugular venous distention), and the arms, hands, ankles and lower back may show signs of fluid overload such as swelling (peripheral edema). The abdomen may be distended due to accumulation of free fluid (ascites); the liver may be enlarged and tender (hepatomegaly). The individual may present with only fluid overload and no signs of organ dysfunction or reduced perfusion. The individual may be comfortable at rest and develop dyspnea, weakness, and fatigue on exertion only. In advanced cases, the heart rate may be rapid even when the individual is sitting or lying down (resting tachycardia). The rapid heart rate may be secondary to sinus tachycardia, or to atrial or ventricular tachyarrhythmias. Blood pressure may be elevated. Auscultation may reveal abnormal heart sounds (displaced apex beat, third heart sound). Respiratory muscle strength may be diminished, resulting in difficulty breathing and decreased endurance. Nausea, vomiting, and intestinal upset can be present. The individual may exhibit confusion; memory impairment, anxiety, and sometimes psychosis and disorientation are observed in elderly patients with advanced cerebrovascular atherosclerosis. In severe heart failure with acute decline in cardiac output, the systolic arterial pressure may be markedly reduced, pulse may be weak and rapid, and the skin may appear bluish (cyanosis).

Tests: Laboratory tests that may be performed include measurement of electrolytes (sodium, potassium, chloride), serum bilirubin, blood urea nitrogen (BUN), albumin and total protein levels, blood glucose, kidney function tests, and liver enzymes (liver function tests). A complete blood count (CBC) is done to assess for anemia or an elevated white cell count. Coagulation tests (prothrombin time, or PT; partial thromboplastin time, or PTT) may be done if the individual is taking anticoagulants to prevent blood clot formation. The amount of oxygen and carbon dioxide in the bloodstream is measured by oxygen saturation measurement, or by full arterial blood gas (ABG) analysis. Tumor necrosis factor-alpha (TNF-alpha) and endothelin-1 (ET-1) may be measured because they contribute to regulation of heart muscle function; both are usually elevated in CHF. B-type natriuretic peptide has become the most used blood test to confirm the presence of heart failure and to quantitate its severity. Urinalysis and 24-hour urine tests may be performed to evaluate albumin, creatinine, and sodium excretion and urinary output. A chest x-ray may show if the heart has increased in size (hypertrophied or dilated) and may differentiate between cardiogenic pulmonary edema and other lung disease. Echocardiography (cardiac ultrasound with duplex Doppler) may be used to evaluate function of the left ventricle and to obtain evidence of ventricular dilation and enlargement (hypertrophy). Transthoracic echocardiography also provides information about heart function and anatomy. Magnetic resonance imaging (MRI) may also be used to evaluate myocardial function and obtain detailed information about valvular disease. Electrocardiography (ECG) is used to identify changes associated with ventricular enlargement and to detect abnormal heart rhythms (arrhythmias), decreased blood flow and oxygen delivery to the heart (myocardial ischemia), or tissue death due to absence of blood flow to a certain region of the heart (myocardial infarction). For class I or II individuals who can withstand the activity, monitoring the heart with ECG while the individual exercises on a treadmill (cardiac stress test) may also be useful in identifying cardiac abnormalities associated with CHF. Six-minute walk tests also provide a good assessment of heart function and prognosis in CHF patients. Pulse oximetry may be done to assess hypoxemia and the severity of heart failure; oxygen saturation can also be monitored with pulse oximetry when supplemental oxygen is being administered.

Procedures that may be done to evaluate heart function include right-sided cardiac catheterization, left-sided cardiac catheterization, and coronary angiography. These invasive procedures are considered when the cause of heart failure is not revealed with noninvasive imaging methods, if heart attack (myocardial infarction) is a likely cause of heart failure, or to determine the severity of underlying valvular disease.

Source: Medical Disability Advisor



Treatment

The individual is commonly put on a low-sodium, low-fat diet and advised to avoid stimulants such as nicotine, caffeine, and alcohol. Lifestyle changes also include following a supervised exercise program as prescribed by a physician, and stress reduction. Individuals with CHF typically receive several different medications as first-line therapy to reduce blood pressure, regulate heart function, and restore fluid balance. Most commonly, drugs may be administered to prevent formation of angiotensin II (angiotensin converting enzyme [ACE] inhibitors) or to inhibit angiotensin II (angiotensin II [A-II] receptor blockers), to enhance heart muscle contractility (inotropic drugs such as digoxin), to reduce hypertension (adrenergic antagonists or beta-blockers), to increase urine output (diuretics), to relax the blood vessels and increase blood flow (vasodilators), and to prevent abnormal heart rhythm (anti-arrhythmics).

Mechanical circulatory support may be used instead of inotropic therapy in selected hospitalized patients to temporarily improve blood flow to the heart and help decrease the heart's workload; these devices include the implanted intra-aortic balloon pump, extracorporeal membrane oxygenator, and left ventricular assist device (L-VAD). There are now left ventricular assist devices that can be surgically implanted in patients with Class 4 heart failure that permit a patient to go home to limited activity while awaiting heart transplantation (availability of a donor heart).

Electrophysiologic treatment is also used in patients with heart failure and conduction abnormalities. Chronic resynchronization therapy (CRT) inserts a biventricular pacemaker under the skin in the left chest and improves heart function by restoring interventricular electrical and mechanical synchrony and reducing mitral regurgitation. Implantable cardioverter-defibrillators are also used increasingly to prevent sudden death due to ventricular arrhythmias in CHF patients.
Telemetric monitoring of blood pressure, temperature, pulse oximetry, and ECG tracings with nursing support via telephone may be used to help manage non-hospitalized patients or those recently discharged. Oxygen may be administered if oxygen saturation is lower than 90%.

Surgical treatment for CHF is usually reserved for individuals in end-stage disease who cannot be treated using drug therapy only. Replacement of the diseased heart with the heart of a donor (cardiac transplantation) is an option for younger patients who are not compromised by other chronic or debilitating illnesses, such as diabetes or cancer, and who are able to withstand surgery; heart transplantation is generally not performed on individuals older than 70 years (Mehra).

Coronary artery bypass grafting is another surgical option for CHF patients with left ventricular failure. Bypass surgery may improve the survival rate in patients whose postoperative left ventricular ejection fractions (LVEFs) are less than 40% (Topkara). Studies have shown that surgical therapy improved the 5-year survival rate to 84%, compared to 70% in patients treated medically (Topkara). However, in-hospital mortality after CABG surgery is elevated in patients with ejection fraction of 20% or less, advanced age, female gender, hepatic failure, renal failure, emergent procedure, myocardial infarction less than 6 hours before the operation, and previous open heart operation. The recommendation is that alternative treatments be considered for those with preoperative hepatic insufficiency and recent MI prior to carrying out elective CABG surgery (Topkara). Aortic valve replacement in patients who developed CHF because of an impaired aortic valve (e.g., aortic stenosis) and mitral valve repair or replacement in CHF patients with mitral regurgitation are performed to decrease CHF symptoms, increase coronary blood flow, and improve survival.

Source: Medical Disability Advisor



Prognosis

Congestive heart failure is a progressive condition with increasing disability, even though advances in medical and surgical treatment have increased the quality of life and life expectancy for those with heart failure (Kearney). The outlook depends upon the age of the individual, the severity of the failure, the underlying cause for the condition, and the presence of concomitant chronic illness (Kearney; Fonarow). Life expectancy for men and woman aged 75 – 85 after first diagnosis of heart failure is about 3.9 and 4.5 years, respectively. For those over 85, it is 2.6 and 1.9 for men and women, respectively (Owen). CHF carries an increased risk of sudden death, and the overall mortality rate is about 20% within one year of diagnosis and 48% within 5 years of diagnosis (Roger). Mortality among patients hospitalized for CHF is about 20% if creatinine and BUN are high (Fonarow). Implantation of mechanical circulatory support devices provides only temporary support. Individuals who are appropriate candidates for cardiac transplantation have fewer hospitalizations, significant functional improvement, better quality of life, continued employment, and increased life expectancy after heart transplantation (Taylor). Following cardiac transplantation, 85% of individuals survive 1 year after surgery; that percentage declines each year thereafter by 3.5% (Taylor).

Source: Medical Disability Advisor



Rehabilitation

Early incorporation of a physical rehabilitation program for CHF may increase survival time. Individuals with the diagnosis of CHF should attend outpatient physical and occupational therapy at a clinic specializing in cardiac rehabilitation. Cardiac rehabilitation centers offer ECG monitoring of all participants during exercise sessions.

Individuals learn to self-monitor their pulse and rate the amount of energy they expend by using a rating-of-perceived-exertion scale. Individuals use their pulse and this scale to stay within safe exercise parameters predetermined by their physicians. Individuals also learn to monitor their weight daily to determine if they are gaining fluid and are instructed to inform their physicians if more than 2 pounds are gained over a period of 24 to 48 hours.

Individuals attend physical therapy to learn basic conditioning and stretching exercises. Initial activities may include limited walking, range of motion, and treadmill exercises. Eventually, more aerobic exercise, including frequent walks, walk-jog, biking, and arm ergometer exercises, may be encouraged. Eventually, exercise may become more strenuous, with a goal of attaining 75% to 85% of maximum intensity while walking, jogging, biking, swimming, performing calisthenics, and / or doing weight training.

Occupational therapy addresses any fatigue or shortness of breath that may occur during activities of daily living. Individuals learn to utilize adaptive equipment to decrease the energy expended, as excessive arm activity is more taxing on the heart and can lead to fatigue. Therapists also teach energy conservation techniques where activities of daily living (ADLs) are broken into smaller components that make tasks more manageable.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical and Surgical
SpecialistHeart Failure, Congestive
Cardiac RehabilitationUp to 3 times/week for 12 weeks, or 36 total visits
This is a generally accepted guideline among US commercial health insurers (was well as within Medicare): http://cms.hhs.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=36&ver=1

Source: Medical Disability Advisor



Complications

Possible complications of congestive heart failure include progression of the heart disease causing difficulty breathing when lying down (orthopnea), abnormal (cyclic) breathing (Cheyne-Stokes respiration), fluid in the lungs (pulmonary edema), decreased oxygen supply to the brain (cerebral hypoxia), fatigue and muscular weakness, and fluid accumulation (congestion) in various body organs. Congestion in the liver may lead to liver dysfunction with mild jaundice. End-organ damage (e.g., myocardial infarction, respiratory failure, hypoxic brain injury) may result from the lack of oxygen delivery to tissues (hypoxemia) in CHF. Progressive renal insufficiency is also commonly associated with heart failure. Recurrence of acute CHF and re-hospitalization within 30 days of treatment and discharge is about 25% (HCUP).

Depression is common in patients with heart failure, increasing the risk of hospitalization and death (Silver).

Postoperative complications after heart transplantation may include development of coronary graft atherosclerosis, the same condition that affected major heart vessels and contributed to CHF.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work activities may be continued and encouraged to the extent that the individual's symptoms allow. Modifications and / or restrictions may be required with work duties that involve medium to heavy physical activity. In this situation, it may be necessary for the individual to return to work at a completely different level, job function, or activity. Individuals whose underlying heart disease can be dramatically improved (such as through coronary artery bypass grafting or valve replacement) may be able to return to moderate or heavy work. Individuals whose disease can only be controlled by medical therapy and who thus have “compensated” but ongoing heart failure can usually only do sedentary or occasionally light work. Most of these individuals meet the U. S. Social Security Administration's criteria for total disability (inability to do any gainful employment).

In work settings that are primarily sedentary, materials and supplies should be organized nearby, and restroom facilities should be easily accessible. Ergonomic seating with the ability to raise the legs may be needed. It may be necessary to limit walking distances that are required to function at work. There should be easy access to the work area and facilities such as parking, elevators, and lunch or break areas. Alternating physical activities with rest periods may be necessary. Shortened work hours or work weeks may be necessary, but this requirement will vary according to the severity of the individual's symptoms.

Risk: As job duties require increasing cardiac demands, the minimum time to return to work will increase. Stress testing and arrhythmia monitoring will help determine safe activity levels. Please refer to "Work Ability and Return to Work," pages 271-273.

Capacity: Capacity as determined by stress testing will guide both therapy and give indications on work recommendations. Restrictions are often needed in more advanced disease despite maximum medical therapy. Please refer to “Ability to Work,” page 274.

Tolerance: Some work accommodations may allow a patient to work despite concerns over their persisting symptoms. Please refer to “Ability to Work,” page 274.

Source: Medical Disability Advisor



Maximum Medical Improvement

Absent any surgical intervention, apart from possible AICD placement, a patient would be at MMI in 84 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • What is the underlying heart condition or precipitating event that caused the CHF?
  • Does individual still have symptoms and clinical findings consistent with the diagnosis of persisting CHF?
  • Was a stress test done to help determine severity of CHF, and current risk and capacity? Has arrhythmia testing (Holter monitor, event monitor, etc.) been performed?
  • Is condition new, or is individual presenting with worsening symptoms, associated with the progression of the heart failure? What CHF NYHA class applies?
  • If diagnosis or cause was uncertain, were additional diagnostic tests or procedures done to rule out other possible conditions?
  • Would individual benefit from consultation with a specialist (cardiologist, cardiac surgeon)?

Regarding treatment:

  • Has individual adopted a low-sodium, low-fat diet? Are stimulants such as nicotine, caffeine, and alcohol being avoided?
  • Was any underlying cause addressed in the treatment plan?
  • Did treatment provide appropriate medications to maximize heart function and minimize symptoms?
  • Did severity of the heart failure warrant intervention with cardiac assist devices?
  • Were electrophysiologic treatments such as pacemaker insertion considered?
  • Was another type of surgery performed, such as coronary artery bypass grafting, aortic valve replacement, or mitral valve repair or replacement? If not, is this type surgery an option?
  • Was individual considered for cardiac transplantation? Is another temporary treatment being applied until a heart is available for transplant?
  • Is individual participating in a cardiac rehabilitation program?

Regarding prognosis:

  • Based on individual's age, severity of heart failure (NYHA class), and treatment, what is the expected outcome?
  • Did individual participate in a cardiac rehabilitation program as recommended? If not, are there obvious barriers to participation (insurance limits, transportation, and motivation)?
  • Did individual suffer any associated complications that would influence length of disability and prognosis? If so, has adequate time elapsed for recovery?

Source: Medical Disability Advisor



References

Cited

Bonow, Robert O. , et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Elsevier Saunders, 2010.

Fonarow, G. C. , et al. "Risk Stratification for in-Hospital Mortality in Acutely Decompensated Heart Failure: Classification and Regression Tree Analysis." The Journal of the American Medical Association 293 (2005): 572-580.

Fonarow, G. C. "Managing the Patient with Diabetes Mellitus and Heart Failure: Issues and Considerations." American Journal of Medicine 116 5A (2004): 76S-88S. PubMed. 20 Oct. 2009 <http://www.ncbi.nlm.nih.gov/pubmed/15019865?dopt=Abstract>.

HCUP. "All-Cause 30 Day Readmission Rate after Hospitalization for Congestive Heart Failure." Assistant Secretary for Planning and Evaluation. 20 Apr. 2012. U.S. Department of Health and Human Services. 31 Jan. 2013 <https://healthmeasures.aspe.hhs.gov/measure/8a>.

Hunt, S. A. , et al. "2009 Focused Update Incorporated into the Acc/Aha 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults." Circulation 119 (2009): e391-e479.

Kearney, M. T. , et al. "Predicting Death Due to Progressive Heart Failure in Patients with Mild-to-Moderate Chronic Heart Failure." Journal of the American College of Cardiology 40 (2002): 1801-1808.

Mehra, M. R. , et al. "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates--2006." Journal of Heart and Lung Transplantation 25 (2006): 1024-1042.

Melhorn, J. Mark, and William Ackerman, eds. Disease and Injury Causation, Guides to the Evaluation of. AMA Press, 2008.

Owen, A. "Life Expectancy of Elderly and Very Elderly Patients with Chronic Heart Failure." American Heart Journal 151 1322 (2006): e1321-e1324.

Roger, V. L. , et al. "Heart disease and stroke statistics--2012 update: a report from the American Heart Association." Circulation 125 (1) (2012): e2-e220.

Silver, M. A. "Depression and Heart Failure: An Overview of What We Know and Don't Know." Cleveland Clinic Journal of Medicine 77 Supp 3 (2010): s7-s11.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Taylor, D. O. , et al. "Registry of the International Society for Heart and Lung Transplantation: Twenty-Fifth Official Adult Heart Transplant Report--2008." Journal of Heart and Lung Transplantation 27 (2008): 943-956.

Topkara, V. K. , et al. "Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction." Circulation 112 (2005): 344-350.

Source: Medical Disability Advisor






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