Air Travel and Cardiovascular Disease

J Travel Med 2004; 11:243–250. Almost two billion passengers undertake international and domestic air travel each year.1,2 As the population ages and our ability to care for patients with cardiac disease improves, an increasing number of people with cardiovascular disease will be traveling long distances.Many such travelers have had pacemakers or automatic defibrillators implanted,have had recent revascularization,or have had surgery which might predispose to deep venous thrombosis (DVT). Recent data drawn from several major US carriers between 1996 and 1997 show 15 deaths among approximately 1.4 million passengers.3 Cardiac events account for the greatest percentage of flight diversions and appear to represent the major cause of in-flight death.3,4 As more patients with severe cardiovascular disease travel, on-board cardiac events might be expected to increase. A general overview with contraindications to air travel and recommendations for the patient with cardiovascular disease is presented in Tables 1 and 2. We will review the pathophysiology and delineate the risk for patients with cardiovascular disease of sudden death, DVT, and ischemia/infarction when they travel by air. On 12 June 2001,the Federal Aviation Administration (FAA) issued a final ruling mandating that passengercarrying aircraft of more than 7,500-lb maximum payload capacity with at least one flight attendant carry at least one automated external defibrillator (AED) and an enhanced emergency medical kit (Table 3).All flight attendants will be required to receive initial and recurrent training on AED usage and in cardiopulmonary resuscitation (CPR). The rule becomes effective on 12 April 2004. Page et al. extrapolated from the data accumulated regarding AED use by one major US airline, and suggested that the widespread availability of AEDs on commercial airlines might prevent up to 93 in-flight deaths from ventricular fibrillation each year worldwide.5 Longterm survival rates in such patients range from 26% to 40%,which compares favorably with the 2% to 5% longterm survival rates often quoted for out-of-hospital arrests.6,7