Return to Work After Coronary Artery Bypass Surgery

Psychosocial and Economic Aspects

Editor: P. J. Walter

With 102 Figures and 204 Tables

Springer-Verlag Berlin Heidelberg New York Tokyo

Prof. Dr. Paul J. Walter Department of Cardiovascular Surgery University Hospital Antwerp Wilrijkstraat 10, B-2520 Antwerp-Edegem, Belgium

ISBN-13: 978-3-642-69857-6 DOI: 10.1007/978-3-642-69855-2

e-ISBN-13: 978-3-642-69855-2

Library of Congress Cataloging in Publication Data. Main entry under title: Return to work after coronary artery bypass surgery. Proceedings of a sym­posium held at Herz-Kreislauf-Zentrum Rotenburg/Fulda, May 10-11, 1984. IncIudes bibliographies and index. 1. Aortocoronary bypass-Pa­tients-Rehabilitation. 2. Aortocoronary bypass-Patients-Employment. 3. Aortocoronary bypass-Patients-Psychology. 4. Aortocoronary bypass­Costs. I. Walter, P. J. (Paul J.), 1935-. [DNLM: 1. Aortocoronary By­pass-rehabilitation-congresses. 2. Employment-congresses. 3. Rehabili­tation, Vocational-economics-congresses. 4. Rehabilitation, Vocational­psychology-congresses. WG 169 R439 1984] RD598.R47 1985 617'.412 85-4620

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© Springer-Verlag Berlin Heidelberg 1985

Softcover reprint of the hardcover I st edition 1985

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Preface

When I gave a presentation on return to work after heart valve replacement at the Tenth Congress of the German Society for Thoracic and Cardiovascular Surgery in 1981, I was surprised by the relatively low level of interest that cardiac surgeons seemed to have in this subject. This stimulated me to intensify my research in this area and to extend it to patients with coron­ary heart disease.

Obviously, physiological and mechanical aspects of medical treatment are of special interest to the surgeon. For the majority of cardiac surgical patients, that is those with coronary heart disease, the technical problems of the operative procedure have been solved to a great extent. Many studies have demonstrated that, aside from reduction of symptoms, aortocoronary bypass operation can lead to improvement of cardiac performance un­der stress conditions. However in spite of the technical solutions to hemodynamic problems, it has become very clear that the reintegration of patients into their social sphere has not been accomplished to the extent that might be expected, as exempli­fied by the relatively low rate of postoperative return to work. Apparently, factors other than hemodynamics and cardiac func­tion impede resumption of the normal lifestyle, enjoyed before the onset of the symptoms of angina pectoris. Return to work after coronary bypass surgery must be seen in a larger psychoso­cial framework, to understand the deeper reasons for the low in­cidence. Factors such as the time spent on the waiting list, the role of family and friends, the expectations of the spouse, moti­vation and guidance from the family doctor, the cardiologist and other hospital staff, and the attitude of employer and colleagues should be studied.

Research should embrace not only, bypass operation, but also percutaneous transluminal coronary angioplasty and con­servative treatment.

The great number of coronary operations (ab out 170000 in the USA in 1983) is a very large burden on the state's social re­sources. The overall cost to the state could be reduced if it were possible to reintegrate a large number of these patients into working life. The expense of the operation could be recovered

VI Preface

within a short time if return to work were increased (higher tax revenue, lower pension and welfare payments).

This book presents the papers from an international sympo­sium which took pi ace on May 10-11, 1984, in the Herz- und Kreislau/zentrum, Rotenburg, Federal Republic of Germany, under the patronage of the International Society of Cardiovas­cular Surgery and the German Society of Thoracic and Cardio­vascular Surgery. The scientific committee consisted of H. G. Borst, Hannover; W. D. Johnson, Milwaukee; F. Loogen, Düsseldorf; G. Rodewald, Hamburg; A. Senning, Zürich; and P. Walter, Antwerp.

For the financial support necessary for the symposium to be held, I would like to thank Pharma Schwarz, Monheim, Federal Republic of Germany, represented by Mr. GÜcker. I would like to say a special word of thanks to Mrs. B. Kratzenberg for her excellent organizational support. I am grateful to all the authors for their cooperation, and to Springer-Verlag, represented by Mr. B. Lewerich and his colleagues, for accurate and rapid pub­lication.

Paul J. Walter

Contents

Return to Work After Coronary Artery Bypass Surgery: Incidence and Main Factors ................ 1

A. J. ANDERSON, J. J. BARBORIAK, R. G. HOFFMANN,

D. C. MULLEN, AND J. A. WALKER

Age- and Sex-Specific Incidence and Main Factors 3

H. H. BENTALL

Psychosocial and Economic Aspects

I. K. CROSBY, J. CHIANG, S. JORDAN, R. L. MENTZER JR.,

I. L. KRON, D. L. KAISER, AND G. B. CRADDOCK JR.

The Influence of Economic and Societal Factors

H. O. VETTER, H. HOFMANN, K. GLONNER, A. NEISS, B. REICHART,

AND W. KLINNER

13

19

Employment Status: Pre- and Postoperative Characteristics 30

R. W. HACKER, H. RIEDL, I. GUGGENMOOs-HoLZMANN,

AND M. TORKA

Employment Status of Patients After Coronary Artery Bypass Surgery . . . . . . . . . . . . . . . . . . . . . 38

M. E. ROTHLIN, R. SIEBER, AND Ä. SENNING

Can Aortocoronary Bypass Surgery Improve Return to Work? ....................... 46

M. WELSCH, G. BERGMANN, D. MAYER, H. C. MEHMEL,

W. SAGGAU, AND W. SCHMITZ

Factors Contributing to Resumption of Work

A. OBERMAN

Summary of the Discussion . . . . . . . . . . .

W. D. JOHNSON, K. L. KAYSER, P. M. PEDRAZA, AND R. T. SHORE

Employment Patterns in Males Before and After Myocardial Revascularization Surgery: A Study of 2229

50

58

Consecutive Patients Followed for as Long as 10 Years. 60

S. NITTER-HAUGE, T. FR0YSAKER, AND S. SIMONSEN

Reemployment Related to Functional and Hemodynamic Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 76

VIII Contents

V. CARSTENS, C. RÖGER, H. SCHMITZ, D. W. BEHRENBECK, AND H. DALlCHAU

Determinants of Vocational Rehabilitation ..... 85

M. SKUPIN, N. REIFART, AND P. SATTER

Incidence of Return to Work in Relation to Invasive, Noninvasive, and Social Parameters . . . . . . . . . . 93

H. GOHLKE, K. SCHNELLBACHER, H. STEINRÜCKEN, L. SAMEK,

AND H. ROSKAMM

Postoperative Exercise Performance Determines Return to Work . . . . . . . . . . . . . . . . . . . 102

P. SERGEANT, E. LESAFFRE, W. FLAMENG, AND R. SUY

Predictability of Postoperative Resumption of Work 108

H. MAGOMETSCHNIGG, W. KLEPETKO, S. HANNA, AND E. DOMANIG

Clinical Results and Return to Work after Coronary Heart Surgery ............................. 112

Z. HYMOWITZ, D. STEIN, T. TROUDART, A. K. DENouR, J. BORMAN, A. ApPELBAUM, AND M. S. GOTSMAN

Working Capacity and Psychological Adjustment Before and After Surgery ................... 115

K. E. HAMMERMEISTER

Summary of the Discussion

Return to Work After Coronary Artery Bypass Surgery

121

in Comparison to Heart Valve Replacement ......... 123

P. J. WALTER, B. IBE, AND M. GOTTWIK

Return to Work After Heart Valve Replacement ...... 125

Return to Work After Coronary Artery Bypass Surgery in Comparison to Medical Treatment . . . . . . . . . 135

A. OBERMAN, C. FISHER, L. MAYNARD, S. M. MULLlN,

E. D. CHARLES JR., AND F. TRISTANI

Long Term Changes in Work Status Among Patients in the Coronary Artery Surgery Study Registry ... 137

K. E. HAMMERMEISTER, T. A. DERoUEN, M. ZIA, AND H. T. DODGE

Comparison of Employment Status Between Medically and Surgically Treated Coronary Artery Disease over 6-7 Years .......................... 148

Contents IX

J. JEHLE, P. GROSSMANN, L. KAMPA, M. KLOKE, A. KRIAN,

AND F. LOOGEN

Return to Work After Surgical and Medical Treatment of Patients with Coronary Artery Disease . . . . . . .. . 155

H. MANNEBACH, U. GLEICHMANN, AND H. SEGGEWISS

Return to Work Aftery Coronary Artery Bypass Surgery in Comparison with Medical Treatment ........... 163

Return to Work After Coronary Artery Bypass Surgery in Comparison to Coronary Angioplasty ........... 169

B. MEIER, V. CHAVES, L. V. SEGESSER, B. FAIDUTII,

AND W. RUTISHAUSER

Vocational Rehabilitation After Coronary Angioplasty and Coronary Bypass Surgery .............. 171

C. VALLBRACHT, G. KOBER, D. SCHERER, AND M. KALTENBACH

Return to Work After Coronary Angioplasty . . . . . . 177

F. BOULAY, P. DAVID, P. R. DAVID, AND M. G. BOURASSA

Work Status and Percutaneous Transluminal Coronary Angioplasty . . . . . . . . . . . . . . . . . . . . . . . . . 183

C. COUSTRY-DEGRE, E. STOUPEL, P. VANDERMOTEN, J. L. LECLERC,

J. STRUYVEN, AND S. DEGRE

Return to Work After Thrombolysis According to the Subsequent Treatment ................. 191

P. G. HUGENHOLTZ

Summary of the Discussion . 193

Psychosocial and Behavioral Aspects of Coronary Artery Bypass Surgery ......................... 201 .

U. GERHARDT

The Discrepancy Between Social and Medical Rehabilitation of Patients with Coronary Heart Disease . 203

M. c. GUTMANN, D. N. KNAPp, AND M. L. POLLOCK

Psychosocial Predictors of Work Status

A. E. WILLNER AND C. J. RABINER

Psychiatrie Complications . . . . . . . .

H.-J. MEFFERT, A. BOLL, G. HUSE-KLEINSTOLL, F. LEMPP,

G. RODEWALD, AND H. SPEIDEL

Benefits and Psychologieal Problems of Aortocoronary

209

214

Bypass and Valve Replacement Surgery ........... 219

X Contents

D. S. KORNFELD, S. S. HELLER, K. A. FRANK, S. N. WILSON, AND J. R. MALM

Psychological and Behavioral Responses ...... ... 224

M. BENYAKAR, S. MIBASHAN, L. LEVINSKY, C. ROSEMBERG, Y. FucHs, AND M. J. LEVY

Return to Work and Sexual Relations Among Patients Following Coronary Artery Bypass Grafting and Myocardial Infarction ............... . . 235

M. J. LEVY, M. BENYAKAR, S. MIBASHAN, L. LEVINSKY,

C. ROSEMBERG, AND Y. FUCHS

Sexual Relations and the Perception of Health and Happiness Among Patients Following Coronary Artery Bypass Crafting and Myocardial Infarction . . . . 246

G. BERGMANN, M. WELSCH, W. SAGGAU, AND H. FERNER

Psychosocial Aspects . . . . . . . . . . . . . . . . . . 257

A. BOLL, J. KOCH, A. SHEIKHZADEH, P. THORAN, AND A.-F. LANGBEHN

Psychological Adaptation of Patients in the Early Rehabilitative Phase After Heart Surgery .....

M. HALHUBER

Some Questions and Remarks

D. S. KORNFELD

Summary of the Discussion . .

265

273

275

Economic Considerations: Costs of Coronary Artery Bypass Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 277

J. J. COLLINS JR.

Comparison of Costs for Medical and Surgical Treatment of Coronary Obstructive Disease . . . . . . . . . . . . . . . 279

P. KALMAR, M.-J. POLONIUS, K.-J. HAHN, I. RADTKE, AND G. RODEWALD

Costs of Open Heart Surgery: ACVB Surgery vs Valve Replacement .................... 285

W. J. KEON, S. C. MENZIES, AND C. M. LAY

The Costing of Coronary Artery Bypass Surgery 292

W. B. STASON AND M. C. WEINSTEIN

Cost-Effectiveness of Coronary Artery Bypass Surgery 299

F. UNGER

Cost-Effectiveness in Coronary Artery Surgery: In Relation to the Gross National Product ... . 307

H. SILOMON

The Contribution of Social Medicine to the Cost-Benefit Analysis of Coronary Bypass Surgery ............ 315

Contents XI

W. B. STASON

Summary of the Discussion .................. 318

Rehabilitation and Return to Work: Strategies for Improving the Work Status of Patients After Coronary Artery Bypass Surgery ......................... 321

N. K. WENGER, D. ALMEIDA, J. M. BRADFORD, S. B. KING,

AND J. W. HURST

Return to Work Mter Coronary Bypass Surgery: Problems and Prospects . . . . . . . . . . . . . . . . . . . . . . 323

F. BOULAY, P. DAVID, N. DANCHIN, AND M. G. BOURASSA

Can We Improve Work Status After Surgery? 332

H. V. LIDDLE, P. D. JONES, B. GOULD, AND P. D. CLA YTON

The Rehabilitation of Patients Following Coronary Revascularization Surgery: Social and Economic Aspects . 341

E. GRODZINSKI, T. FENTROP, T. KELLER, G. BIERCK, J. S. BORER,

W. SCHOOP, AND G. BLÜMCHEN

The Significance of Radionuclide Ventriculography for the Prognosis and Social Fate of Heart Infarction Patients (With or Without Left Ventricular Aneurysm) 354

R. A. M. ERDMAN, AND P. G. HUGENHOLTZ

Comparison of Active Participation in the Rotterdam Outpatient Cardiac Rehabilitation Pro gram and Horne Rehabilitation: A 5-Year Follow-up of a Controlled Clinical Trial on Psychological Well-Being: A Presentation on Behalf of CAPRI ........ .... 365

W. F. DION, M. L. POLLOCK, C. FOSTER, P. GREVENOW,

S. SENNETT, AND D. H. SCHMIDT

Medical Problems and Hemodynamic Responses of Myocardial Revascularization Surgery Patients to Early Cardiac Rehabilitation . . . . . . . . . . . . . . . . . . . . . 369

G. STEIN, H. JUNG MANN, E. O. KRASEMANN, AND M. ZOTHNER

Inability to Work After Myocardial Infarction: A 5-Year Follow-up Study ....................... 375

B. RIGLER, F. IBERER, J. KRAFT-KINZ, AND W. KLEIN

Postoperative Work Rehabilitation ..... .

C. SEIDEL, U. STOCKSMElER, AND R. WEGSCHEIDER

Survival After Return to Work .....

A. VERMEULEN, J. J. KOOLEN, A. C. MOULIJN,

AND N. SLANGEN-SCHOTERMANN

380

386

Cardiac Rehabilitation: Influence on Work Resumption 390

N. K. WENGER

Summary of the Discussion . . . . . . . . . . . . . . . .. 394

List of Contributors

Almeida, D., Emory University School of Medicine, 69 Butler Street, S. E., Atlanta, GA 30303, USA

Anderson, A J., Division of Biostatistics, Medical College of Wisconsin, P.O.Box 26509, Milwaukee, WI 53226, USA

Appelbaum, A, Department of Surgery, Hadassah-Hebrew University Hospital, IL-Jerusalem 92-585, Israel

Barboriak, J. J., Department of Pharmacology and Toxicology, Medical College of Wisconsin, Biochemistry Section, Research Service 151 B, Wood, WI, USA

Behrenbeck, D. W., Medizinische Klinik 111 und Herzchirurgische Klinik der Universität zu Köln, Joseph-Stelzmann-Straße 9, D-5000 Köln 41, FRG

Bentall, H. H., Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London W12 OHS, GB

Bergmann, G., Medizinische Klinik der Universität, Abteilung Innere Medizin 11, Bergheimer Straße 58, D-6900 Heidelberg, FRG

Birck, G., Klinik Roderbirken, D-5653 Leichlingen/Rhld. 1, FRG

Blümchen, G., Klinik Roderbirken, D-5653 Leichlingen/Rhld. 1, FRG

Boll, A, Rehabilitationszentrum Bad Segeberg, Kurpark, D-2360 Bad Segeberg, FRG

Borer, J. S., New York Hospital, Cornell University, New York, NY, USA

Bormann, J., Department of Surgery, Hadassah-Hebrew University Hospital, IL-Jerusalem 92-585, Israel

Boulay, F., Höpital Central, Centre Hospitalier Regional de Nancy, 29 av de Lattre de Tassigny, F-54500 Vandoeuvre, France

Bourassa, M. G., Institut de Cardiologie de Montreal, 500 E Rue Belanger, Montreal, Quebec, HIT IC8, CDN

XIV List of Contributors

Bradford, J. M., Emory University School of Medicine, 69 Butler Street, S. E., Atlanta, GA 30303, USA

Carstens, V., Medizinische Klinik III der Universität zu Köln, Joseph-Stelzmann-Straße 9, D-5000 Köln 41, FRG

Charles, E. D. Jr., School of Public Heahh, University of Alabama in Birmingham, University Station, Birmingham, AL 35294, USA

Chaves, V., Department de Cardiologie, Universite de Geneve, CH-1211 Geneve, Switzerland

Chiang, J., Department of Surgery, University of Virginia Medical Center, P.O.Box 181, Charlottesville, VA 22908, USA

Clayton, P. D., Department of Thoracic and Cardiovascular Surgery, LDS Hospital, Sah Lake City, UT, and the Department of Medical Biophysics and Computing, University of Utah and LDS Hospital, Sah Lake City, UT, USA

Collins, J. J. Jr., Division of Thoraeie and Cardiac Surgery Brigham and Momen's Hospital, 75 Francis Street, Boston, MA 02115, USA

Coustry-Degre, C., Cliniques Universitaire de Bruxelles, Höpital Academique Erasme, Universite Libre de Bruxelles, 808 Route de Lennik, B-I070 Bruxelles, Belgium

Craddock, G. B. Jr., Department of Internal Medicine (Cardiology Division), University of Virginia Medical Center, P.O.Box 181, Charlottesville, VA 22908, USA

Crosby, I. K., Baylor Medical Plaza, 3600 Gaston Ave., 1201 Barnett Tower, Dallas, TX 75246, USA

Dalichau, H., Herzchirurgische Klinik der Universität zu Köln, Joseph-Stelzmann-Straße 9, D-5000 Köln 41, FRG

Danchin, N., Höpital de Brabois, Centre Hospitalier Regional de Nancy, Route de Neufchateau, F-54500 Vandrevre les Nancy, France

David, P., Institut de Cardiologie de Montreal, 5000 E Rue Belanger, Montreal, Quebec, HIT IC8, CDN

David, P. R., Institut de Cardiologie de Montreal, 5000 E Rue Belanger, Montreal, Quebec, HIT IC8, CDN

Degre, S., Cliniques Universitaires de Bruxelles, Höpital Academiques Erasme, Universite Libre de Bruxelles, 808 Route de Lennik, B-I070 Bruxelles, Belgium

DeRouen, T. A., School of Public Health, University of Washington, Seattle, WA, USA

List of Contributors XV

Oion, W. F., Cardiac Rehabilitation Pro gram, Mount Sinai Medical Center, University of Wisconsin Medical School, 950 N. 12th Street, Milwaukee, WI 53233, USA

Oodge, H. T., University of Washington, Seattle, WA, USA

Oomanig, E., 11. Chirurgische Universitätsklinik Wien, Spitalgasse 23, A-1090 Wien, Austria

Erdman, R. A. M., Erasmus Universiteit Rotterdam, Fakulteit der Geneeskunde, Thoraxcenter, Postbus 1738, NL-3000 OR Rotterdam, The Netherlands

Faidutti, B., Oepartment de Cardiologie, Universite de Geneve, CH-1211 Geneve, Switzerland

Fentrop. T., Klinik Roderbirken, 0-5653 Leichlingen/Rhld. 1, FRG

Fisher, C., Coordinating Center for CASS, University of Washington, Seattle, WA, USA

Flameng, W., Cardiovascular Surgery Oepartment, University Hospital Gasthuisberg, Heretraat, B-3000 Leuven, Belgium

Foster, C., Cardiac Rehabilitation Program, Mount Sinai Medical School, University of Wisconsin Medical School, 950 N. 12th Street, Milwaukee, WI 53233, USA

Frank, K. A., Oepartments of Psychiatry and Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA

Ff0ysaker, T., Medical Oepartment B, Rikshospitalet, University Hospital, Oslo, Norway

Fuchs, Y., Thoracic and Cardiovascular Surgery Oepartment, Beilinson Medical Center, Tel Aviv University Medical School, IL- Tel Aviv 63474, Israel

Gerhardt, U., Institut für Medizinische Soziologie, Friedrichsstraße 24, 0-6300 Giessen, FRG

Gleichmann, U., Gollwitzer-Meier-Institute, 0-4970 Bad Oeynhausen, FRG

Glonner, K., Klinik Höhenried für Herz- und Kreislaufkrankheiten, 0-8139 Bernried/Obb., FRG

Gotsman, M. S., Oepartment of Cardiology, Hadassah-Hebrew­University Hospital, IL- Jerusalem 92-585, Israel

Gohlke, H., Rehabilitationszentrum für Herz- und Kreislaufkranke, Südring 15,0-7812 Bad Krozingen, FRG

XVI List of Contributors

Gottwik, Mo, Kerckhoffklinik, Benekestraße 2, D-6350 Bad-Nauheim, FRG

Gould, B., Department of Thoracic and Cardiovascular Surgery, LDS Hospital, Salt Lake City, and the Department of Medical Biophysics and Computing, University of Utah and LDS Hospital, Salt Lake City, UT, USA

Grevenow, Po, Cardiac Rehabilitation Program, Mount Sinai Medical Center, University of Wisconsin Medical School, 950 No 12th Street, PoOoBox 342, Milwaukee, WI 53233, USA

Grodzinski, Eo, Klinik Roderbirken, D-5653 Leichlingen/Rhldo 1, FRG

Grossmann, Po, Medizinische Klinik und Poliklinik B, und Chirurgische Klinik B, Universität Düsseldorf, Moorenstraße 5, D-4000 Düsseldorf, FRG

Guggenmoos-Holzmann, I., Chirurgische Klinik und Institut für medizinische Statistik und Dokumentation der Universität Erlangen-Nürnberg, Maximiliansplatz, D-8520 Erlangen, FRG

Gutmann, Mo c., University of Wisconsin Medical School, Milwaukee Clinical Campus, Mount Sinai Medical Center, 950 No 12th Street, PoOoBox 342, Milwaukee, WI 53201, USA

Hacker, R. Wo, Herz- und Gefäßklinik, Salzburger Leite 1, D-8740 Bad Neustadt, FRG

Halhuber, Mo, An der Gotardslust 17, D-5920 Bad Berleburg, FRG

Hammermeister, K. Eo, Veterans Administration Medical Center, University of Colorado Health Sciences Center, Denver, 1055 Clermont Street, CO, USA

Hahn, Ko-Jo, Abteilung für Herz- und Gefäßchirurgie, Chirurgische Universitätsklinik Hamburg, Martinistraße 52, D-2000 Hamburg 20, FRG

Hanna, So, 110 Chirurgische Universitätsklinik Wien, Spital gasse 23, A-I090 Wien, Austria

Heller, So So, Departments of Psychiatry and Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA

Hoffmann, Ro Go, Division of Biostatics, Medical College of Wisconsin, PoOoBox 26509, Milwaukee, WI 53226, USA

Hofmann, Ho, Klinik Höhenried für Herz- und Kreislaufkrankheiten, D-8139 Bernried/Obbo,. FRG

List of Contributors XVII

Hugenholtz, P. G., Erasmus Universiteit Rotterdam, Fakulteit der Geneeskunde, Thoraxcenter, Postbus 1738, NL-3000 DR Rotterdam, The Netherlands

Hurst, J. W., Emory University School of Medicine, 69 Butler Street S.E., Atlanta, GA 30303, USA

Huse-Kleinstoll, G., Universitäts krankenhaus Eppendorf, Abteilung für Herz- und Gefäßchirurgie, Martinistraße 52, D-2000 Hamburg 20, FRG

Hymowitz, Z., Department of Cardiology, Hadassah-Hebrew University Hospital, IL- Jerusalem 92-585, Israel

Ibe, B., Klinik für Herz- und Gefäßchirurgie, Justus-Liebig-Universität, Klinikstr. 29, D-6300 Giessen, FRG

Iberer, F., Universitätsklinik für Chirurgie, Auenbruggerplatz 1, A-8036 Graz, Austria

Jehle, J., Medizinische Klinik B, Universität Düsseldorf, Moorenstraße 5, D-4000 Düsseldorf, FRG

Johnson, W. D., Milwaukee Heart Surgery Associates, S. C., Thoracic and Cardiovascular Surgery, 3112 West Highland Boulevard, Milwaukee, WI 53208, USA

Jones, P. D., Department of Thoracic and Cardiovascular Sur­gery, LDS Hospital, Salt Lake City, UT, and the Department of Medical Biophysics and Computing, University of Utah and LDS Hospital, Salt Lake City, UT, USA

Jordan, S., Department of Surgery, University of Virginia Medical Center, P.O.Box 181, Charlottesville, VA 22908, USA

Jungmann, H., Curschmann-Klinik, D-2408 Timmendorfer Strand, FRG

Kaiser, D. L., Department of Internal Medicine (Cardiology Division), University of Virginia Medical Center, P.O.Box 181, Charlottesville, VA 22908, USA

Kalmar, P., Abteilung für Herz- und Gefäßchirurgie, Chirurgische Universitäts klinik Hamburg, Martinistraße 52, D-2000 Hamburg 20, FRG

Kaltenbach, M., Johann-Wolfgang-Goethe-Universität, Zentrum Innere Medizin, Abteilung für Kardiologie, Theodor-Stern-Kai, D-6000 Frankfurt/Main, FRG

Kampa, L., Medizinische Klinik und Poliklinik B, und Chirurgische Klinik B, Universität Düsseldorf, Moorenstraße 5, D-4000 Düsseldorf, FRG

XVIII List of Contributors

Kaplan OeNour, A., Oepartment of Psychiatry, Hadassah-Hebrew University Hospital, IL- Jerusalem 92-585, Israel

Kayser, K. L., 3112 West Highland Boulevard, Milwaukee, WI 53208, USA

Keller, T., Klinik Roderbirken, 0-5653 Leichlingen/Rhld. 1, FRG

Keon, University of Ottawa Heart Institute and Faculty of Administration, Program in Health Administration, Civic Hospital, 737, Park Oale Avenue, Ottawa K14148, CON

King, S. B., Emory University School of Medicine, 69 Butler Street, S. E., Atlanta, GA 30303, USA

Klein, W., Universitätsklinik für Chirurgie, Auenbruggerplatz 1, A-8036 Graz, Austria

Klepetko, W., 11. Chirurgische Universitäts klinik Wien, Spitalgasse 23, A-I090 Wien, Austria

Klinner, W., Herzchirurgische Klinik, Klinikum Großhadern, Marchioninistraße 15, 0-8000 München 70, FRG

Kloke, M., Medizinische Klinik und Poliklinik B, und Chirurgische Klinik B, Universität Oüsseldorf, Moorenstraße 5, 0-4000 Oüsseldorf, FRG

Knapp, D. N., University of Wisconsin Medical School, Milwaukee Clinical Campus, Mount Sinai Medical Center, Milwaukee, WI 53201, USA

Koch, J., Rehabilitationszentrum Bad Segeberg, Kurpark, 0-2360 Bad Segeberg, FRG

Kober, G., Johann-Wolfgang-Goethe-Universität, Zentrum Innere Medizin, Abteilung für Kardiologie, Theodor-Stern-Kai, 0-6000 Frankfurt/Main, FRG

Koolen, J. J., Academisch Ziekenhuis, Universiteit van Amsterdam, Meijbergdreef9, NL-ll05 AZ Amsterdam Zuidoost, The Netherlands

Kornfeld, D. S., Presbyterian Hospital, 622 W., 168th Street, New York, NY 10032, USA

Kraft-Kinz, J., Universitätsklinik für Chirurgie, Auenbruggerplatz 1, A-8036 Graz, Austria

Krasemann, E. 0., Curschmann-Klinik, 0-2408 Timmendorfer Strand, FRG

List of Contributors XIX

Krian, A., Medizinische Klinik und Poliklinik B, und Chirurgische Klinik B, Universität Oüsseldorf, Moorenstraße 5, 0-4000 Oüsseldorf, FRG

Kron, I. L., Oepartment of Surgery, University of Virginia Medical Center, P.O.Box 181, Charlottesville, VA 22908, USA

Langbehn, Rehabilitationszentrum Bad Segeberg, Kurpark, 0-2360 Bad Segeberg, FRG

Lay, C. M., University of Ottawa Heart Institute and Faculty of Administration, Program in Health Administration, Civic Hospital, 737 Park Oale Avenue, Ottawa K14148, CON

Ledere, J. L., Cliniques Universitaire de Bruxelles, Höpital Academique Erasme, Universite Libre de Bruxelles, 808 Route de Lennik, B-1070 Bruxelles, Belgium

Lempp, F., Universitäts krankenhaus Eppendorf, Abteilung für Herz- und Gefäßchirurgie, Martinistraße 52, 0-2000 Hamburg, FRG

Lesaffre, E., Medical Informatics Oepartment, University Hospital Gasthuisberg, Herestraat, B-3000 Leuven, Belgium

Levinski, L., Thoraeie and Cardiovascular Surgery Oepartment, Beilinson Medical Center, Tel Aviv University Medical School, IL- Tel Aviv 63474, Israel

Levy, M. J., Thoraeie and Cardiovascular Surgery Oepartment, Beilinson Medical Center, Tel Aviv University Medical School, IL- Tel Aviv 63474, Israel

Liddie, H. V., Oepartment of Thoracic and Cardiovascular Surgery, LOS Hospital, Salt Lake City, UT, and the Oepartment of Medical Biophysics and Computing, University of Utah and LOS Hospital, Salt Lake City, UT, USA

Loogen, F., Medizinische Klinik und Poliklinik B, Universität Oüsseldorf, Moorenstraße 5, 0-4000 Oüsseldorf, FRG

Magometschnigg, H., 11. Chirurgische Universitäts klinik Wien, Spitalgasse 23, A-1090 Wien, Austria

Malm, J. R., Oepartment of Psychiatry and Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA

Mannebach, H., Gollwitzer-Meier- Institute, 0-4970 Bad Oeynhausen, FRG

XX List of Contributors

Mayer, H. C., Chirurgische Klinik der Universität, Abteilung für Spezielle Thoraxchirurgie, Im Neuenheimer Feld 110, D-6900 Heidelberg, FRG

Meffert, H.-J., Universitätskrankenhaus Eppendorf, Abteilung für Herz- und Gefäßchirurgie, Martinistraße 52, D-2000 Hamburg, FRG

Mehmel, W., Medizinische Klinik der Universität, Abteilung Innere Medizin III, Bergheimer Straße 58, D-6900 Heidelberg, FRG

Meier, B., Centre de Cardiologie, Höpital Cantonal Universitaire, CH-1211 Geneve 4, Switzerland

Mentzer, R. L., Departments of Surgery and University of Virginia Medical Center, P.O.Box 181, Charlottesville, VA 22908, USA

Menzies, S. c., University of Ottawa Heart Institute and Faculty of Administration, Pro gram in Health Administration, Civic Hospital, 737 Park Dale Avenue, Ottawa K14148, CDN

Mibashan, S., Thoracic and Cardiovascular Surgery Department, Beilinson Medical Center, Tel Aviv University Medical School, IL- Tel Aviv 63474, Israel

Moulijn, A. C., Cardiopulmonary Surgery, Akademisch Ziekenhuis, Universiteit van Amsterdam, Meijbergdreef 9, NL-ll05 AZ Amsterdam, The Netherlands

Mullen, D. c., Cardiovascular Surgical Associates, 9800 West Bluemound Road, Milwaukee, WI 53226, USA

Neiss, A., Institut für Medizinische Statistik und Epidemiologie, Technische Universität, D-8000 Müchen, FRG

Nitter-Hauge, S., Laboratory of Cardiology, Medical Department B, Rikshospitalet, University Hospital, Oslo, Norway

Oberman, A., Department of Preventive Medicine, University of Alabama in Birmingham, University Station, Birmingham, AL 35294, USA

Pedraza, P. M., Milwaukee Heart Surgery Associates, S. C., Thoracic and Cardiovascular Surgery, 3112 West Highland Boulevard, Milwaukee, WI 53208, USA

Pollock, M. L., Cardiac Rehabilitation Program, Mount Sinai Medical Center, University of Wisconsin Medical School, 950 N. 12th Street, Milwaukee, WI 53233, USA

List of Contributors XXI

Polonius, Mo-Jo, Abteilung für Herz- und Gefäßchirurgie, Chirurgische Universitäts klinik Hamburg, Martinistraße 52, D-2000 Hamburg 20, FRG

Rabiner, C. Jo, Long Island Jewish-Hillside Medical Center, GIen Oaks, New York, NY 11004, USA

Radtke, 1., Abteilung für Herz- und Gefäßchirurgie, Chirurgische Universitäts klinik Hamburg, Martinistraße 52, D-2000 Hamburg 20, FRG

Reichart, Bo, Herzchirurgische Klinik, Klinikum Großhadern, Marchioninistraße 15, D-8000 München 70, FRG

Reifart, No, Johann-Wolfgang-Goethe-Universität, Zentrum für Chirurgie, Abteilung für Thorax-, Herz- und Gefäßchirurgie, Theodor-Stern-Kai, D-6000 Frankfurt/Main, FRG

Riedl, Ho, Chirurgische Klinik und Institut für medizinische Statistik und Dokumentation der Universität Erlangen-Nürnberg, Maximiliansplatz, D-8520 Erlangen, FRG

Rigler, Bo, Universitäts klinik für Chirurgie, Auenbruggerplatz 1, A-8010 Graz, Austria

Rodewald, Go, Universitätskrankenhaus Eppendorf, Abteilung für Herz- und Gefäßchirurgie, Martinistraße 52, D-2000 Hamburg 20, FRG

Röger, Co, Medizinische Klinik III und Herzchirurgische Klinik, Universität zu Köln, Joseph-Stelzmann-Straße 9, D-5000 Köln, FRG

Rosemberg, c., Thoracic and Cardiovascular Surgery Department, Beilinson Medical Center, Tel Aviv University Medical School, IL- Tel Aviv 63474, Israel

Roskamm, Ho, Rehabilitationszentrum für Herz- und Kreislaufkranke, Südring 15, D-7812 Bad Krozingen, FRG

Rothlin, Mo Eo, Chirurgie A, Universitätsspital, CH-8091 Zürich, Switzerland

Rutishauser, Wo, Centre de Cardiologie, Höpital Cantonal Universitaire, CH-1211 Geneve 4, Switzerland

Saggau, Wo, Chirurgische Klinik der Universität, Abteilung für Spezielle Thoraxchirurgie, Im Neuenheimer Feld 110,

. D-6900 Heidelberg, FRG

. Samek, L., Rehabilitationszentrum für Herz- und Kreislaufkranke, Südring 15, D-7812 Bad Krozingen, FRG

XXII List of Contributors

Satter, P., lohann-Wolfgang-Goethe-Universität, Zentrum für Chirurgie, Abteilung für Thorax-, Herz- und Gefäßchirurgie, Theodor-Stern-Kai, 0-6000 Frankfurt/Main, FRG

Scherer, 0., lohann-Wolfgang-Goethe-Universität, Zentrum Innere Medizin, Abteilung für Kardiologie, Theodor-Stern-Kai, 0-6000 Frankfurt/Main, FRG

Schmidt, O. H., Cardiac Rehabilitation Pro gram, Mount Sinai Medical Center, University of Wisconsin Medical School, 950 N. 12th Street, Milwaukee, WI 53233, USA

Schmitz, H., Medizinische Klinik III und Herzchirurgische Klinik der Universität zu Köln, loseph-Stelzmann-Straße 9, 0-5000 Köln, FRG

Schmitz, W., Chirurgische Klinik der Universität, Abteilung für Spezielle Thoraxchirurgie, Im Neuenheimer Feld 110, 0-6900 Heidelberg, FRG

Schnellbacher, K., Rehabilitationszentrum für Herz- und Kreislaufkranke, Südring 15, 0-7812 Bad Krozingen, FRG

Schoop, W., Aggertalklinik, 0-5250 Engelskirchen, FRG

Segesser, L. v., Oepartment de Cardiologie, Universite de Geneve, CH-1211 Geneve, Switzerland

Seggewiss, H., Gollwitzer-Meier-Institute, 0-4970 Bad Oeynhausen, FRG

Seidel, c., Fachkrankenhaus für Psychosomatik und Ourchblutungserkrankungen, Oorfstr. 18, 0-8139 Bernried/Starnberger See, FRG

Sennett, S., Cardiac Rehabilitation Pro gram, Mount Sinai Medical Center, University of Wisconsin Medical School, 950 N. 12th Street, Milwaukee, WI 53233, USA

Senning, Ä., Universitäts spital, CH-8091 Zürich, Switzerland

Sergeant, P., Cardiovascular Surgery Oepartment, University Hospital Gasthuisberg, Herestraat, B-3000 Leuven, Belgium

Sheikhzadeh, A., Rehabilitationszentrum Bad Segeberg, Kurpark, 0-2360 Bad Segeberg, FRG

Sieber, R., Chirurgie A, Universitätsspital, CH-8091 Zürich, Switzerland

Shore, R. T., Milwaukee Heart Surgery Associates S. C., Thoracic and Cardiovascular Surgery, 3112 West Highland Boulevard, Milwaukee, WI 53208, USA

Silomon, H., Schölebergstraße 22/3, 0-4500 Osnabrück, FRG

List of Contributors XXIII

Simonsen, S., Laboratory of Cardiology, Medical Department B, Rikshospitalet, University Hospital, Oslo, Norway

Skupin, M., Johann-Wolfgang-Goethe-Universität, Zentrum für Chirurgie, Abteilung für Thorax-, Herz- und Gefäßchirurgie, Theodor-Stern-Kai, D-6000 Frankfurt/Main, FRG

Stason, W. B., Harward School of Public Health, Center for the Analysis of Health Practices, 677 Huntington Avenue, Boston, MA 02115, USA

Stein, D., Department of Psychiatry, Hadassah-Hebrew University Hospital, IL- Jerusalem 92-585, Israel

Stein, G., Curschmann-Klinik, D-2408 Timmendorfer Strand, FRG

Steinrücken, H., Rehabilitationszentrum für Herz- und Kreislaufkranke, Südring 15, D-7812 Bad Krozingen, FRG

Stocksmeier, u., Institut für Sozialmedizin, Prävention und Rehabilitation e. V., Höhenbergstraße 12, D-8132 Tutzing b. München, FRG

Stoupel, E., Cliniques Universitaires de Bruxelles, Höpital Academique Erasme, Universite Libre de Bruxelles, 808 Route de Lennik, B-I070 Bruxelles, Belgium

Struyven, J., Cliniques Universitaires de Bruxelles, Höpital Academique Erasme, Universite Libre de Bruxelles, 808 Route de Lennik, B-I070 Bruxelles, Belgium

Suy, R., Cardiovascular Surgery Department, University Hospital Gasthuisberg, Herestraat, B-3000 Leuven, Belgium

Thoran, P., Rehabilitationszentrum Bad Segeberg, Kurpark, D-2360 Bad Segeberg, FRG

Torka, M., Chirurgische Klinik und Institut für medizinische Statistik und Dokumentation der Universität Erlangen-Nürnberg, Maximiliansplatz, D-8520 Erlangen, FRG

Tristani, F., Veterans Administration Hospital, Wood, Milwaukee, WI, USA

Troudart, T., Department of Psychiatry, Hadassah-Hebrew University Hospital, IL- Jerusalem 92-585, Israel

Unger, F., I. Universitäts klinik für Chirurgie, Anichstraße 35, A-6020 Innsbruck, Austria

Vallbracht, c., Johann-Wolfgang-Goethe-Universität, Zentrum Innere Medizin, Abteilung für Kardiologie, Theodor-Stern-Kai, D-6000 Frankfurt/Main, FRG

XXIV List of Contributors

Vandermoten, P., Cliniques Universitaires de Bruxelles, Höpital Academique Erasme, Universite Libre de Bruxelles, 808 Route de Lennik, B-I070 Bruxelles, Belgium

Vermeulen, A, Akademisch Ziekenhuis, Universiteit van Amsterdam, Akademisch Medisch Zentrum, Meibergdreef 9, NL-11 05 AZ Amsterdam Zuidoost, The N etherlands

Vetter, H. 0., Department of Cardiovascular Surgery, University of Munich, Klinikum Großhadem, Marchioninistr. 15, D-8000 München 70, West-Germany

Walker, J. A, Cardiovascular Associates Limited, 2975 S. 29th Street, Suite 300, Milwaukee, WI 53215, USA

Walter, P. J., Cardiovasculaire Heelkunde, Akademisch Ziekenhuis Antwerpen, Wilrijkstraat 10, B-2520 Edegem, Belgium

Wegscheider, R., Institut für Sozialmedizin, Prävention und Rehabilitation e. V., Höhenbergstraße 12, D-8132 Tutzing b. München, FRG

Welsch, M., Chirurgische Klinik der Universität, Abteilung für Spezielle Thoraxchirurgie, Im Neuenheimer Feld 110, D-6900 Heidelberg, FRG

Wenger, N. K., Emory University School of Medicine, 69 Butler Street, S. E., Atlanta, GA 30303, USA

Willner, A E., Long Island Jewish-Hillside Medical Center, Gien Oaks, NY, USA

Wilson, S. N., Departments of Psychiatry and Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA

Zothner, M., Curschmann-Klinik, D-2408 Timmendorfer Strand, FRG