Cardiovascular screening and long-term outcomes in aircraft pilots

Q: What are the key findings of this study?

Among asymptomatic aircraft pilots referred for cardiac assessment, the incidence of major adverse clinical events was 15% over a median follow-up of 5.15 years.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular risk in asymptomatic aircraft pilots (n=212). Intervention: Occupational exposure as aircraft pilots. Primary outcome: Major adverse clinical event (MACE) defined as death, myocardial infarction, stroke, major arrhythmia, heart failure event or cardiac-related hospitalisation.

Q: What does this research mean for the field?

Asymptomatic aircraft pilots referred for cardiac assessment exhibit underlying cardiovascular risk factors and a 15% incidence of major adverse clinical events over a median 5.15-year follow-up, despite maintaining high functional capacity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Wiaam Elkhatib; Thomas R Flipse; Thomas G. Allison; Leigh L. Speicher; Hanna J. Sledge; Z. Li; Brian P. Shapiro; S. Michael Gharacholou

doi:10.1136/heartjnl-2024-325243

March 4, 2025Heart

Cardiovascular screening and long-term outcomes in aircraft pilots

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Key result

Referred asymptomatic pilots face a ~15% rate of MACE over five years.

n=212

Key Points

To evaluate cardiovascular risk factors, cardiac diagnostic findings, and long-term clinical outcomes in asymptomatic aircraft pilots referred for specialist cardiovascular assessment.
Retrospective cohort analysis of N=212 asymptomatic aircraft pilots referred for cardiac evaluation between January 1991 and May 2023.
Assessed baseline clinical risk factors, functional exercise capacity, and transthoracic echocardiography findings, defining aortic dilation as diameter ≥40 mm.
Followed patients over a median follow-up of 5.15 years (range: 0.1 to 31.82 years) to measure major adverse clinical events using Kaplan-Meier methods.
Common baseline comorbidities included hyperlipidemia (48%), hypertension (32%), and sleep apnea (15%), with imaging identifying aortic dilation in 16% and significant valvular disease in 2.4%.
Functional testing revealed high aerobic fitness, averaging 109±24.6% functional capacity and 11.89±2.65 metabolic equivalents, with <8% showing ischemic changes on stress electrocardiography or echocardiography.
Over the 32-year study window, cumulative incidence of major adverse clinical events was 15%, with six individuals undergoing coronary angiography and two receiving percutaneous coronary intervention.

Study Design

Type

Observational (n=212)

Structured PICO

P

Population

212 asymptomatic aircraft pilots (mean age 58.5 years, 91% male) referred for cardiac assessment, followed for a median of 5.15 years.

O

Outcome

Major adverse clinical event (MACE) defined as death, myocardial infarction, stroke, major arrhythmia, heart failure event or cardiac-related hospitalisationcomposite

Implication

Asymptomatic aircraft pilots demonstrate good overall functional capacity and long-term outcomes, though the 16% prevalence of aortic dilatation highlights the need for careful structural screening.

Abstract

BACKGROUND: Pilots face significant occupational risks affecting cardiometabolic health and are subject to regulatory health screenings. Cardiometabolic risk factors, cardiac screening findings and outcomes among pilots have not been well reported. OBJECTIVES: This study aimed to investigate cardiac evaluations of asymptomatic aircraft pilots and the association between clinical risk factors and outcomes. METHODS: Asymptomatic aircraft pilots referred for cardiac assessment between January 1991 and May 2023 were studied. Baseline characteristics, cardiac test findings and outcomes were evaluated. Major adverse clinical event (MACE) was defined as death, myocardial infarction, stroke, major arrhythmia, heart failure event or cardiac-related hospitalisation and estimated using Kaplan-Meier methods. Significant valvular disease by echocardiography was defined as stenosis, regurgitation or prolapse of moderate severity or greater. Aortic dilation by transthoracic echocardiogram (TTE) was defined as measuring ≥40 mm in diameter. RESULTS: 212 pilots met eligibility criteria for the study. The majority were white (92.9%) and male (91%) with a mean age of 58.5±10.9 years. Mean body mass index was 27.8±4.8 with comorbid hyperlipidaemia (48%), hypertension (32%), prior cancer (27%), sleep apnoea (15%), arrhythmia (12%) and known coronary artery disease (6%). Imaging revealed significant valvular disease (2.4%) and dilated aortas (16%) based on TTEs. Functional cardiac testing performed showed mean functional aerobic capacity of 109±24.6% reaching 11.89±2.65 metabolic equivalents with <8% showing positive findings per EKG or wall motion abnormalities on exercise TTE. Six patients received coronary angiography based on clinical evaluation, with two undergoing percutaneous coronary intervention. Over a 32-year period with a median (range) follow-up of 5.15 (0.1, 31.82) years, MACE incidence was 15%. CONCLUSIONS: Asymptomatic aircraft pilots have underlying cardiovascular risk factors but good overall functional capacity, long-term outcomes and life expectancy. Prevalence of cardiac structural findings like aortic dilatation warrants increased attention during examination of these patients.

Discussion

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Cite This Study

Elkhatib et al. (2025) conducted an observational in Cardiovascular risk in asymptomatic aircraft pilots (n=212). Occupational exposure as aircraft pilots was evaluated on Major adverse clinical event (MACE) defined as death, myocardial infarction, stroke, major arrhythmia, heart failure event or cardiac-related hospitalisation. Among asymptomatic aircraft pilots referred for cardiac assessment, the incidence of major adverse clinical events was 15% over a median follow-up of 5.15 years.

synapsesocial.com/papers/6a8816102d13770579f4d573 https://doi.org/10.1136/heartjnl-2024-325243

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Cardiovascular screening and long-term outcomes in aircraft pilots

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Cardiovascular screening and long-term outcomes in aircraft pilots

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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