CVD patients cleared for air travel
MedWire News: New guidelines by the British Cardiovascular Society (BCS) state that air travel is "safe" for the majority of patients with cardiovascular disease (CVD).
The report, devised by a BCS working group after consultation with aviation experts and clinical specialists, provides thorough guidance on patients with CVD of all severities and highlights restrictions that should be considered before flying.
"It is only when their underlying condition is associated with a significant risk of acute deterioration that reasonable restrictions should apply," say David Smith (Royal Devon and Exeter NHS Foundation Trust, UK) and team, the authors of the BCS guidance.
They note: "It is generally the instability of the condition that predicts risk rather than the severity alone," and therefore advise that although patients with CVD can fly safely, they should be well prepared before doing so.
Carrying an adequate supply of medication and informing the airline of any need for in-flight oxygen in advance are among the preparatory measures recommended in the guidance.
Smith et al name hypobaric hypoxia, a low blood oxygen secondary to low oxygen concentrations in pressurised cabins, as the "most significant physiological change that occurred during flight," and say that patients with a high risk for angina, myocardial infarction (MI), heart failure, or arrhythmias may be affected by hypobaric hypoxia.
However, the team explains that the resulting hypoxia is usually mild and likely to have "little or no effect in precipitating MI" in those who were not ischemic prior to the flight.
The guidance, published in the journal Heart, also states that patients with stable angina or pacemakers are safe to fly, but patients with arrhythmias are advised to medically confirm that their arrhythmias are appropriately controlled before flying.
Chronic heart failure patients may also fly; however, the authors advise that such patients avoid physical exertion at the airport and continue with their usual medication regime, allowing for time zone differences.
They state that after an acute MI or elective percutaneous coronary intervention, a patient should wait 6 weeks and 2 days, respectively, before flying.
The guidance also confirms that a long-haul flight doubles the risk for deep vein thrombosis (DVT) and venous thromboembolism (VTE), but the authors emphasize that this risk, estimated at one in 6000 for a healthy person flying for more than 4 hours, is similar to that for any other form of inactive travel for the same period of time.
Smith et al say that, while patients at high risk for DVT, such as those with a history of the condition, are also fit to fly, they advise that these patients wear compression stockings, keep fluid intake high, and take a blood thinner, other than aspirin.
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By Lauretta Ihonor