Air travelers with cardiovascular disease remain safe – with some recommendations

A review article by Yale researchers reaffirms that the vast majority of people with cardiovascular disease can travel safely on airlines, provided they follow basic guidelines such as carrying an ample supply of medication or waiting two weeks to travel after having a cardiac procedure.

Published in the July 20 issue of Annals of Internal Medicine, the article reviewed previous studies on air travel and cardiovascular disease. “We pulled together work that has been done on the topic, synthesized the findings and created evidence-based guidelines,” said first author Stephen E. Possick, M.D., a cardiology fellow at Yale School of Medicine. “While other guidelines exist, ours detail both the reasons those with cardiovascular disease might be at increased risk and the data that support the safety of airline travel in most travelers with cardiovascular disease.”

Concern about air travel by cardiovascular patients exists because altitude can decrease the oxygen content in blood and impair the breakdown of blood clots, potentially leading to complications. Currently there are few medical incidents on airlines: about eight medical incidents per one million flights, according to Possick. Of these incidents, 19.4 percent were cardiac related.

Cardiovascular patients who have been re-vascularized–have undergone angioplasty, stenting or bypass surgery–now tend to live longer and have a better quality of life. The guidelines Possick and Barry outlined in their review include refraining from travel for two weeks after coronary stent placement or three weeks after coronary artery bypass surgery, as most complications tend to happen within this time period in non-traveling patients.

The review also provides a pre-travel checklist for patients, which recommends that travelers carry an ample supply of medication, a copy of a health history, and contact numbers for physicians and family members. The review also outlines other steps such as discussing travel with an internist or cardiologist, who can then determine if any pre-flight testing is warranted.

During travel the authors suggest that those over age 50 or younger than 50 with risk factors for venous thrombosis, wear below-the-knee compression stockings, and offer tips for traveling safely through airline security. Possick said patients with pace makers and defibrillators might set off metal detectors. They should carry a card showing that they have the device and request a hand-held search.
“Our hope is that these guidelines will reassure both patients and physicians and provide some simple steps for insuring safe travel for the millions of patients with heart disease who are now able to travel and have a quality of life that would not have been possible 25 years ago,” said Possick, who collaborated on the study with senior author Michele Barry, M.D., professor of medicine and public health and director of the Office of International Health.