Background: The present study was designed to investigate the trend and determinant factors among cardiac disabled workers presented in the years 2003-2005 at Health Insurance Committee for disability rating in Alexandria and to compare the currently used system with others. Methods: A retrospective study was conducted to review complete records for those below the age 65 years. The available data were coded to include age, gender, job title, disabling symptoms, presence or absence of abnormal findings in resting electrocardiogram and chest X-ray. Extra-investigations were considered by the committee in some cases including echocardiography, cardiac stress test and coronary angiography. Therapeutic interventions were coded and etiological diagnosis was classified into ischemic heart disease (IHD), rheumatic heart disease (RHD), hypertension (HT) and cardiomyopathies (CM). The functional diagnosis was reported as presence or absence of heart failure and disability was rated as partial or total. Results: The resultsrevealed that rates of disabling dyspnoea, CM and heart failure were significantly increasing from year to year (p=0.038, 0.039 & 0.023 respectively). The most common etiological diagnosis for the presented cases was IHD with high rates ranging from 69.7% to 73.6% across the 3 years. Logistic regression with total disability as the dependent variable showed that heart failure and additional information by echocardiography were the independent determinants (p= 0.020 & 0.004 respectively). Simplified comparison between current cardiac disability rating system and American medical Association impairment classification was given. Conclusion: The present disability rating system lack standardization and quantification. It is recommended to integrate the metabolic equivalent (METs) measurement  with the current system and to emphasize cardiovascular preventive programs to control cardiac disability.