Common procedures for coronary heart disease

What is this?

If blood vessels in the heart narrow as the result of a build up of fatty deposits or if symptoms cannot be controlled using medication then interventional procedures or surgery maybe need to open up or bypass blocked arteries.

What are the different procedures used to treat blocked arteries?

Coronary angioplasty
Coronary angiogram
Coronary artery bypass graft surgery

Coronary angioplasty and coronary angiogram, including using a balloon to push the fatty tissue in the narrowed artery out or the insertion of a metal stent are procedures that take between 30 minutes and two hours and you can normally go home the same day, if this is planned procedure (non emergency). However, often these procedures are carried out in response to an emergency medical condition such as a heart attack which will require the person to stay in hospital for several days after the procedure.

The hospital team will usually advise about how long it will take to recover and if there are any activities you need to avoid. In most cases you will be advised to avoid heavy lifting and strenuous activities for about a week and until the wound has healed.

Work

You should avoid driving a car for a week after coronary angioplasty and if you drive a heavy vehicle such as a bus or a lorry you must inform the DVLA, your employer should refer you to Occupational Health for a driver health assessment.

If you had planned (non-emergency) coronary angioplasty and do not drive as part of your job then you should be able to return to work after 1 week.

Coronary artery bypass graft surgery (CABG)

How will the procedure affect people?
This is a surgical procedure carried out in order to divert blood around narrowed or clogged parts of the major arteries in the heart to improve blood flow and oxygen supply to the heart. This requires a vessel to be taken from another part of the body and attaching it to the coronary artery near the blocked area. The new blood vessel is known as a graft. The procedure is carried out under general anaesthetic and takes between 3-6 hours.

Whilst this surgery takes some time to recover from and everyone takes slightly different times to recover, most people make a full recovery within 12 weeks and will have resumed some normal activities after about 6 weeks, including driving and working.

Getting back to work
How quickly an individual returns to work depends on a how well they heal, how they have responded to the surgery and the type of job they do.

The Royal College of Surgeons provides the following advice regarding returning to work:
People whose work involves a lot of heavy lifting, standing up, or walking for long periods of time, will not be able to return to work as quickly as those who have office jobs which are less demanding physically.

If the work undertaken involves only light physical exertion – i.e., it does not involve standing for periods of more than 20 minutes, lifting more than 5kg at a time, or carrying it for any significant distance, then a return to normal work can be expected 6-8 weeks after surgery. Certainly, most people will find themselves fit to work by two to three months after the operation.

Where the individual works in a workplace with access to an occupational health service the line manager should make a referral so that further advice can be provided on a return to work plan.

Rehabilitation plan

There should be a review at the end of each week of any rehabilitation plan by the line manager to ensure that the employee is coping with the return to work. The manager should also check that the employee feels able to increase their hours and their work activities in line with the above advice until they are back to normal duties.

Returning to driving duties

For ordinary drivers (Group 1), the Driver and Vehicle Licensing Agency (DVLA) do not need to be informed, but driving must cease for at least 4 weeks. Driving may recommence thereafter provided there is no other disqualifying condition.

Drivers who drive LGVs or PSVs (Group 2) are disqualified from driving for at least 3 months. Re/licensing may be permitted after that period provided:

There is no evidence of significant impairment of heart function

The exercise test requirements can be met 3 months or more following surgery

There is no other disqualifying condition

Employees should be referred to Occupational Health if the line manager is concerned that the employee is not making progress as expected, for example:

They are unable to return to normal duties after four weeks following a return to work on modified duties

Advice is required on whether they can return to a previous role if they were on amended or modified duties prior to the CABG

Advice is required regarding permanent redeployment

Advice is required about driving

Points to Remember

Fit notes

If an employee produces a fit note indicating that they require modified duties, discuss this with them and consider if the modification recommended can be reasonably accommodated.

Job tasks and risk assessments

Review the risk assessment for the employee’s job role and work tasks including the ability to drive safely where required. Take into consideration any temporary modification that may be required to accommodate their reduced ability to undertake certain tasks.

General guidance

If you require further information, refer to the general advice on managing attendance.