A Washington University scientist has been working with the federal government to answer questions about heart disease and disability.
Serving on an Institute of Medicine (IOM) committee on cardiovascular disability, Robert M. Carney, PhD, helped prepare updates on how to evaluate cardiac disability. Interestingly, Carney is not a cardiologist. Rather, he’s a behavioral medicine specialist whose research is devoted to how psychiatric illness, depression in particular, increases risk for a second heart attack and for sudden cardiac death.
Carney, a professor of psychiatry and director of Washington University’s Behavioral Medicine Center, says sometimes it’s not possible to determine cardiac disability with a stethoscope or an echocardiogram.
“People can become depressed or anxious, and they may start isolating themselves socially following a cardiac event,” he says. “How an individual deals with distress related to heart disease can affect whether or not that individual becomes disabled.”
Almost 11 million adults and 1 million children are classified as disabled by the Social Security Administration (SSA). But Carney says when dealing with disability, it isn’t always easy to figure out what is truly disabling versus what is merely difficult to overcome. The SSA uses a screening tool called the Listing of Impairments – or the Listings – to identify those so severely impaired that they cannot work. The Listings are updated every few years to keep up with advancements in science and medicine.
Carney and the rest of the IOM panel recommended updates to the heart disease Listings. Although the extent of heart disease remains a key factor, Carney says the committee agreed that how a person actually functions is the proper “litmus” test for disability.
“In the past, the Listings focused mainly on anatomy, defining severity by the anatomic characteristics of heart disease,” he explains. “But anatomy is only part of the disability question. People with very severe heart disease can function quite well while others with less severe heart disease may be severely disabled.”
The committee recommended functional testing be used to determine cardiac disability. Functional testing includes treadmill tests, stress echocardiograms and other examinations of how the heart functions in various situations. Collecting information about how an individual does performing day-to-day activities also is recommended. Plus, the group also suggested evaluating patiens for depression and other mood disorders.
“There are physical issues associated with depression that are likely to impair functioning,” Carney says. “As a matter of fact, most studies of depression and heart disease have shown that on their own, each of these conditions are among the most debilitating of any chronic medical condition. When someone has both together, the problems are compounded.”
The SSA will evaluate the committee’s recommendations and update the Listings over the next few months.
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.