Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
CHOI CH (1), HO MH (2), NG SP (2), LI MK (2), WONG MY (3)
Affiliation :
(1) Department of Medicine & Geriatrics, (2) Department of Physiotherapy, (3) Department of Occupational Therapy, Pok Oi Hospital
Introduction :
Landmark publications by the American Heart Association and American College of Sports Medicine in 1990s established the safety and supported RTP of high-intensity exercise for post-MI CR participants. Medical Fitness-To-Work determination is a well-documented expected performance for CR centers according to the international guidelines. However, heterogeneous practices among CR centers persist.
Objectives :
To evaluate the outcomes of modern international guidelines-directed practice adopted by POH CR team on referral for post-MI RTP and RTW.
Methodology :
Case reports: Two patients were identified and followed up after referral to POH CR team for evaluation between 2019 and 2023.
Result & Outcome :
Case 1: A 39-year-old policeman was referred to POH CR center for evaluation of RTP high-intensity jogging exercise. Four years earlier, he sustained acute MI-related cardiac arrest in a badminton game. He resumed jogging exercise upon hospital discharge but felt frustration after completion of an out-patient CR program of a local traditional CR center providing mainly moderate-intensity training and limiting his exercise to brisk walking due to conservative heart rate recommendation. POH CR Team offered him international guidelines-directed, moderate-to-high intensity training under medical supervision after passing maximal treadmill test. He was satisfied with medical clearance for jogging exercise resumption, advice on self-monitoring skill and cardiac risk factors control. No cardiovascular (CV) event recurred for 48-month follow-up.
Case 2: A 53-year-old public bus driver wanted to resume duty following acute MI and percutaneous coronary intervention performed at a public hospital. He attended a local traditional CR center and was given advice to discuss with bus company officer-in-charge and doctor-in-charge for non-driving work. He was then referred by his parent Cardiac team to POH CR team for further evaluation. Although he failed exercise testing criteria, medical clearance was granted to him for RTW as bus driver after passing guidelines-directed cardiac functional imaging study as alternative work-up option offered by CR Team in the absence of disqualifying conditions. No CV event-related traffic accident was documented in 32-month follow-up.
Adopting modern CR practice is the key success to support post-MI RTP and RTW.
