From the Guidelines
I would not recommend returning to offshore work at this time for someone with post-viral cardiomyopathy with an ejection fraction (EF) below 20% just two months ago. This represents severe cardiac dysfunction that requires more recovery time and medical stabilization, as indicated by the 2013 ACCF/AHA guideline for the management of heart failure 1. Typically, patients with such severe cardiomyopathy need at least 6-12 months of optimal medical therapy and demonstrated improvement in cardiac function before considering return to physically demanding or remote work environments.
Current treatment should include medications like an ACE inhibitor (such as lisinopril 10-40mg daily), a beta-blocker (such as carvedilol 3.125-25mg twice daily), an aldosterone antagonist (spironolactone 25-50mg daily), and possibly SGLT2 inhibitors (like dapagliflozin 10mg daily), as recommended in the 2013 ACCF/AHA guideline for the management of heart failure 1.
Before considering return to offshore work, the following conditions should be met:
- Achieve an EF improvement to at least 35-40%
- Complete a cardiac rehabilitation program
- Undergo exercise stress testing to demonstrate adequate functional capacity
- Have implantable cardioverter-defibrillator placement considered if EF remains below 35% after optimal medical therapy, as suggested by the guideline for treatment of Stage B HF 1
The offshore environment presents particular risks including limited medical access, physical demands, and potentially stressful conditions that could worsen cardiac function or trigger life-threatening arrhythmias in someone with severely compromised cardiac function. Monthly cardiology follow-ups with repeat echocardiograms every 3-6 months are necessary to monitor recovery progress, in line with the recommendations for LVEF assessment and symptom management in patients with heart failure 1.
From the Research
Fitness for Work at Offshore
- The question of fitness for work at offshore for an individual with post-viral cardiomyopathy 2 months ago, with an ejection fraction (EF) below 20, is complex and requires careful consideration of various factors.
- According to the studies, there is no direct evidence to support a specific guideline for fitness for work at offshore for individuals with post-viral cardiomyopathy and severely reduced EF 2, 3, 4, 5, 6.
- However, it is known that individuals with heart failure and reduced ejection fraction (HFrEF) require optimal medical treatment, including beta-blockers, ACE inhibitors, and other medications to manage their condition 3, 6.
- Device therapy, such as implantable cardioverter-defibrillators and cardiac resynchronization therapy, may also be considered for patients with HFrEF 3.
- In the case of post-viral cardiomyopathy, treatment is largely supportive and may include oxygen therapy, intravenous hydration, diuretics, steroids, and antivirals 4.
- The risk of sudden cardiac death (SCD) is a significant concern in patients with myocarditis and cardiomyopathy, and the use of cardiac magnetic resonance imaging (CMR) and late gadolinium enhancement (LGE) can help identify patients at high risk of SCD 5.
Considerations for Offshore Work
- Offshore work can be physically demanding and may pose additional risks for individuals with heart conditions, such as increased stress, physical exertion, and limited access to medical care.
- The decision to allow an individual with post-viral cardiomyopathy and severely reduced EF to work offshore should be made on a case-by-case basis, taking into account the individual's overall health, medical treatment, and ability to perform their job duties safely.
- It is essential to consider the potential risks and benefits of offshore work for individuals with heart conditions and to develop strategies to mitigate these risks, such as regular medical monitoring, emergency response planning, and provision of necessary medical equipment and personnel.