Routine exercise ECG screening in military aircrew yielded very low rates of findings requiring further investigation (0.2% to 1.2% across groups) and resulted in only 3 ultimate disqualifications.
Observational (n=11,463)
No
11,463 military aircrew applicants and active-duty pilots undergoing screening exercise electrocardiograms at a single center in Germany.
Exercise electrocardiogram (ExECG) screening
ExECG findings requiring further investigation or disqualification
INTRODUCTION: The exercise electrocardiogram (ExECG), or stress test, is a widely used screening tool in occupational medicine designed to detect occult coronary artery disease, and assess performance capacity and cardiovascular fitness. In some guidelines, it is recommended for high-risk occupations in which occult disease could possibly endanger public safety. In aviation medicine, however, there is an ongoing debate on the use and periodicity of ExECG for screening of aircrew. METHOD: In the German Armed Forces, aircrew applicants and active-duty aircrew undergo screening ExECG. We analyzed 7646 applicant ExECGs (5871 from pilot and 1775 from nonpilot applicants) and 17,131 ExECGs from 3817 active-duty pilots. All were performed at the German Air Force Centre of Aerospace Medicine (GAFCAM) and analyzed for ECG abnormalities, performance capacity, blood pressure, and heart rate response. RESULTS: Only 15/5871 (0.2%) of pilot applicants required further investigation and none were ultimately disqualified for aircrew duties due to their ExECG results. Of the nonpilot applicants, 22/1775 (1.2%) required further diagnostic work-up due to their ExECG findings, with only 1 ultimately disqualified. From active-duty pilots, 84/17,131 (0.5%) ExECGs revealed findings requiring further investigation, with only 2 pilots ultimately disqualified from flying duties. DISCUSSION: The extremely low yield of ExECG findings requiring further evaluation and/or disqualification for aircrew duties suggest its use is questionable and not cost-effective as a screening tool in this cohort. It may be enough to perform ExECG on clinical indication alone. Guettler N, Nicol ED, Sammito S. Exercise ECG for screening in military aircrew . Aerosp Med Hum Perform. 2022; 93(9):666–672.
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Norbert Guettler
Justus-Liebig-Universität Gießen
Edward Nicol
Cardiac Imaging
Stefan Sammito
Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)
Aerospace Medicine and Human Performance
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Guettler et al. (Thu,) conducted a observational in Screening for occult coronary artery disease (n=11,463). Exercise electrocardiogram (ExECG) screening was evaluated on ExECG findings requiring further investigation or disqualification. Routine exercise ECG screening in military aircrew yielded very low rates of findings requiring further investigation (0.2% to 1.2% across groups) and resulted in only 3 ultimate disqualifications.
synapsesocial.com/papers/6a21c6997a665884467c29b0 — DOI: https://doi.org/10.3357/amhp.6051.2022
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