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Air travel advice for people with heart disease

Most people with heart conditions can safely travel by air, according to a new report from the British Cardiovascular Society. The advice is based on evidence from research, where available, and on the opinion of experts, where no evidence exists.

What do we know already?

There has been debate for years about the effects of air travel on the body. Passengers need to stay seated for a long time, in an atmosphere with less oxygen than we're used to breathing on the ground. One well-known problem is a blood clot in a vein (a deep vein thrombosis, or DVT).

In addition, it's difficult to get medical treatment on a plane, in the case of a health emergency.

Doctors have been concerned that people with heart conditions might experience health problems on flights. The reduced amount of oxygen in the air means that the heart needs to work harder to pump blood around the body. Reduced oxygen can also increase blood pressure and make people feel breathless. Guidance on when it's safe to fly varies between different groups of doctors, leading to confusion for patients and for airlines.

The British Cardiovascular Society is a professional association of doctors working in heart medicine in the UK. They've studied all the evidence about risks to people's heart health from flying, and drawn up some guidelines on who can safely fly. The guidelines include advice on how soon people can fly after a heart attack or after heart surgery. They also make recommendations for avoiding deep vein thrombosis. They say the guidelines are intended to be used as advice for people with heart conditions, rather than by airlines to decide who they will and won't take on a flight.

What does the new study say?

These groups of people can fly without any special treatment:

  • People with mild angina (chest pain) that only happens during moderate exercise, whose condition and medicine has not changed recently

  • People with mild heart failure, which causes breathlessness on mild to moderate exercise, whose condition and medicine has not changed within six weeks

  • People with occasional heart palpitations or irregular heartbeat, whose condition doesn't cause fainting and who are being treated.

People with more serious angina and heart failure, or people born with heart problems, are advised to consider whether they need extra assistance at the airport, and oxygen during their flights. If they are getting symptoms that indicate their condition might get suddenly worse, they are advised to wait until their condition is stable before travelling by air.

If someone has had a heart attack, they should be able to fly after three days if they're under 65, have had the blocked artery successfully opened, and their heart is pumping normally. Older people who are not breathless and don't have chest pain should wait 10 days. People whose heart is not pumping properly, who are still breathless, or who need further tests or treatment, should wait until their condition is stable.

People who've had a pacemaker or defibrillator fitted, or who have had their arteries widened by a balloon or stent, can fly after two days, providing there are no complications from their operation. People who've had a coronary artery bypass graft should wait 10 days, assuming there are no complications.

The guidelines say people are at low risk of a DVT if they have never had one before, have not had an operation in the past eight weeks, and don't have any other risk factors. For these people, the guidelines recommend keeping mobile, drinking plenty of non-alcoholic drinks, not smoking, and avoiding caffeine or drugs that make you drowsy.

People at moderate risk include those who've had a DVT before, who are pregnant, who've had surgery four to eight weeks previously, who are known to have blood that clots easily, or who are very overweight (obese). For these people, the guidelines recommend wearing compression stockings as well as taking the steps above.

People at high risk include those with a previous DVT who also have another risk factor, such as having cancer, or who've had surgery during the past four weeks. These people can still fly, but they may need injections of an anti-clotting drug (called enoxaparin) before and after the flight. They should also wear stockings and take the other safety precautions.

How reliable are the findings?

The authors themselves say that there is little good-quality evidence about the effects of flying on health. Most of the guidelines are therefore based on the authors' professional judgement and understanding about how problems such as angina and heart failure are affected by low-oxygen conditions.

Where does the study come from?

The report was written by a group of doctors from the British Cardiovascular Society. They were published in the medical journal Heart, which is published by the BMJ Group.

What does this mean for me?

If you have a heart condition, and you're concerned about whether it's safe for you to fly, these guidelines give you some advice. For the majority of people with heart conditions, flying is not a problem. However, it's worth discussing the situation with your own doctor, in case there are special factors which might make it less advisable for you. These guidelines only look at heart problems, not other medical conditions that may affect you.

What should I do now?

Smith D, Toff W, Joy M, et al. Fitness to fly for passengers with cardiovascular disease. Heart. 2010; 96: ii1-ii16.

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Reference

Jul 21, 2010