Options for diabetic patients with chronic heel ulcers

Which are the determinants of return to work in middle aged myocardial infarction patients? This question was analysed by means of a follow-up study on men between 1986 and 1992 (group 1: n = 64, age = 46.6 (+/- 5.4), 5-6 years follow-up; group 2: n = 36, age = 51.2 (+/- 7.5), 2 years follow up), all of whom underwent a cardiac rehabilitation program in our hospital. Our aim was to determine the predictive power of social and psychological as compared to cardiologic factors. These factors were operating under two relevant conditions: 1. relative social homogeneity of the samples; 2. rehabilitation including qualified cardiologic diagnostic and an interdisciplinary therapeutic program. As a result we found age--at the same time a biologic and a social variable--to be the best independent predictor in logistic regression as in discriminant analysis. Age was followed by hopelessness in the year before MI, ST segment depression in physical stress test and, with restriction, marital status. Thus our study points to three factors limiting employment status: age as a biological and social limit for achievement, ST segment depression as a coronary and ongoing hopelessness as a psychological limit, with a social background of living alone in some cases. It is important for cardiac rehabilitation to take into account not only biological but also social and psychological limits of work capacity. Comprehensive care tries to modify these limits but cannot remove them.