Cardiovascular Disease: Heart Failure and Non-ischemic Cardiomyopathies

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Heart Failure (HF)

Law enforcement officers (LEOs) with mild heart failure (HF) may be capable of safe and effective job performance. However, HF increases the risk of sudden incapacitation and is associated with reduced exercise capacity, thus jeopardizing the LEO’s ability to perform essential job functions (see LEO Essential Job Functions chapter).1,2 Therefore, an individualized assessment of the LEO with HF (see Appendix A) is needed to ensure safe and effective job performance. Any underlying structural heart disease should be assessed according to the appropriate section of this document.

Two common classification systems group/stage HF patients based on severity and prognosis: 1) the New York Heart Association (NYHA)3; and 2) the American College of Cardiology Foundation/American Heart Association (ACCF/AHA)4 (see Table 1). LEOs with HF grouped as a NYHA I or staged as an ACCF/AHA A or B can return to full duty if all the following criteria are met:

• asymptomatic;
• normal 12-lead electrocardiogram (ECG);
• normal 24-hour ECG;
• normal left ventricular function defined by a normal ejection fraction (EF) as measured by a gated blood pool scan, 2-dimensional echocardiogram with Doppler, or ventriculogram;
• normal imaging exercise stress test (EST) to at least 12 METs (see EST in Coronary Artery Disease section);
• stable regimen of cardiovascular medications over the past month11;
• no disqualifying side effects from medications (see LEO Medications chapter);

The above criteria should be reassessed on an annual basis unless the LEO’s HF is due to a reversible condition as described in the next paragraph.

If the LEO has HF due to a reversible condition (e.g., hyperthyroidism, obesity, inflammation, etc.), the LEO should be provided restrictions. Once the underlying condition and HF have resolved and all the above criteria are met, the LEO can return to work without restrictions. No ongoing cardiac testing is indicated for these reversible HF conditions.

LEOs with a NYHA classification II, III, or IV or an ACCF/AHA Stage C or D should be given job restrictions due to: a) the risk of sudden incapacitation, and b) the lack aerobic capacity to perform all essential job functions.