Returning to work after a major trauma like a Sudden Cardiac Arrest can be a very difficult thing to gauge and over the years there have been quite a few posts in our group about this subject.
One of the major issues that SCA survivors have that perhaps many other cardiac patients don’t experience is a brain injury. When in cardiac arrest the body will go into a state of hypoxia – low oxygen, CPR will help but within a few minutes, brain cells will start to die. If the patient is resuscitated successfully this “downtime” will almost certainly result in some form of impairment, such as memory issues, fatigue, lack of concentration/focus and psychological issues.
These impairments may be considered transient or mild by some but can still have a devastating effect on a person’s ability to work. Unfortunately, many survivors won’t actually be given any formal diagnosis and may be unaware of why they are experiencing the issues they are. They may even attribute them to other reasons such as age, or medications they are taking. In addition, many of these impairments are essentially “invisible” to a casual observer and combined with the confusion between a cardiac arrest and heart attack, an ill-informed person may misinterpret their issues as a lack of will to work.
If a survivor receives an Implantable Cardioverter Defibrillator (ICD) they will receive a driving suspension for 6 months, and possibly longer should they receive an appropriate shock. In addition, if they were a Group 2 (HGV/bus) licence-holder, they will no longer be allowed to drive this class of vehicle.
If you receive an ICD and work with machinery you should be aware of any potential conflicts – such as electrical magnetic interference. Everyday household or office equipment should not be an issue but some larger machines and tools like some welders can potentially be off-limits.
It’s worth noting that if you are a survivor and feel fit enough to work but are unable to travel easily you may qualify for the Access to Work scheme. Under certain circumstances, you can have your transport to work costs covered or partly covered by the government, for example, a taxi to cover your daily commute. We know of several of our members have had some success with this scheme.
A poll was conducted in the group asking members if, and how soon they returned to work. Options were given for <3 months, 3-6 months, 6-12 months, 1-2 years, <2 years, other, non-worker before+after, temporary non-worker and non-worker. Where “non-worker before+after” relates to those who may have been retired, or a non-working age, “temporary non-worker” is for those who had an SCA recently and were still off work, “non-worker” was for those who were long term off work, or who had to retire early. “Other” catered for any other situations such as someone who had had to retire, but then later took up a different part-time role.
As you can see just over 50% returned within the first year, but more than 1 in 4 were currently a non-worker, either temporarily or long term.
A number of studies have been carried out on returning to work post out of hospital cardiac arrest (OHCA).
In 2015, a study from Denmark examined the period from 2001 to 2011. Of the 796 survivors, it showed that 76.6% returned to work with a median period of 4 months. It showed that the factors increasing the likelihood of returning included the later years (Denmark had a push to improve OHCA survival rates), male sex, younger age (<50), bystander witness and layperson CPR.
A 2018 study, Return to Work and Participation in Society After Out-of-Hospital Cardiac Arrest aimed to describe OHCA survivors’ ability to participate in activities of everyday life and society, including the return to work. The specific aim was to evaluate the potential effects of cognitive impairment.
287 OHCA survivors were in the study which showed that less than half had returned to work 6 months after their event, in addition, nearly half of the cardiac arrest survivors reported more restricted participation in everyday life and society, such as difficulty with self-care, relationships and leisurely activities.
The categorisation of cognitive function for OHCA survivors resulted in 25% with no cognitive impairment, 29% with mild/borderline scores of cognitive impairment, and 47% with cognitive impairment.
The study concluded…
We report that even when crude outcome scales demonstrate a good recovery, OHCA survivors reported a more restricted societal participation at 6 months post-arrest, and their return to work was lower compared with STEMI (Heart Attack) controls. Cognitive impairment was significantly associated with lower participation, together with symptoms of fatigue, depression, and mobility problems. On the basis of our results, we recommend that these symptoms should be addressed during follow-up, to identify those OHCA survivors who may benefit from further support and rehabilitation to maximize return to work and societal participation.
A 2018 Paris study of 153 survivors found that around 63% returned to work with factors associated with better odds of returning to work being a younger age, being managers/professionals/service/sales/clerical and a workplace occurrence.
In 2020 an Australian study of 884 OHCA survivors showed that 73% returned to work. Increasing age, the traumatic nature of the arrest and labour intensive occupations were associated with decreased odds of returning to work.
The study concluded…
more research is required but certain cohorts of survivors are indeed at risk of not returning to work and they would benefit from targeted rehabilitation strategies.
As you can see the scientific research results are not that different to our group poll, with upwards of 3/4 returning to work. Of course, conversely, this means a sizeable number does not return and maybe with the right rehab this could be reduced more?
If you are struggling and are lucky enough to be able to access occupational therapy. Occupational therapists help you overcome any challenges you have so that you can live your best life at home and at work. This can be a great way to help you get back into work. OT can be accessed through your GP and some employers. One of our members, Willem wrote and spoke about his experience with occupational therapy when he returned to work.
How To Cope
- It is important that you are honest with your employer and close colleagues so that you do not put yourself under too much pressure. Flexible working patterns can be useful to begin with.
- Build up both physical and mental activity gradually.
- Be honest and realistic about how you are getting on.
- You may feel unexpectedly tired by your work at first; avoid stressful situations and go to bed early.
- Where physical requirements are too much for you, it may be necessary to retrain or find alternative duties at your workplace. If your work has an occupational health department, they can be a useful source of support and information.
- If you are told you cannot continue in your previous employment there is help available for retraining or changing occupation. Ask for an appointment to discuss this at your local job centre or careers advice department.
When your job is mentally demanding or stressful it is important to learn some stress management skills, including time management. A simple rule of thumb regarding time management is to split your day into thirds: one-third sleep, one-third work and one-third social and leisure activities.
There was some good feedback on the poll and other work-related posts regarding “how soon was right to return” and the underlying theme was that our recoveries are all unique and don’t rush back…
…go when u feel your ready as long as your doctor says it’s ok. We all heal at different speeds but make sure your both physically and mentally okNic
It takes as long as it takes. Different people have different experiencesWillem
,give yourself enough time to recover. Your body has gone through a major event and needs recovery time
…nurses and physios who run them [cardiaca rehab] are best placed to assess your physical capability to work. But your emotional and psychological capability is less predictable and you might find things triggering a reaction at the most unexpected of timesBrian
A number of people suggested that a phased return worked well for them as it allowed them to adjust over a period of time. One thing I had noticed though is that no one had said that they hadn’t returned to work and from reading some studies I knew that a notable percentage don’t return to work.
3rd Party Advice
There is little specific advice for cardiac arrest survivors but there will be a general overlap with many of the other serious cardiac conditions:
After our first meet-up in February 2015, I realised I was not alone. It was the first time since my cardiac arrest the previous year that I had spoken face-to-face with someone who had experienced what I had. This was also true for my wife, who also happened to be my lifesaver. From that meet-up, the idea of SCA UK was born. Since then, we have achieved a considerable amount, primarily providing information, resources and support to others in a similar situation but also raising the profile of survivorship and the need for better post-discharge care. We are starting to get traction in this, and with the formation of the charity, I genuinely believe we have a bright future ahead and will make a significant difference in the lives of many who join our ranks.