Can people with heart disease fly?

It is holiday or vacation time in many parts of the world and many people are travelling by car, boat, train or plane, with the mode of transport mainly determined by distance. Summer school break is definitely the peak season for flying as people have more time for longer and farther trips. But how safe is air travel for those who have heart problems and other chronic conditions?

The British Cardiovascular Society recently issued a guidance on the safety of travelling on a commercial aircraft that will help both primary health care clinicians and their patients.

But first of all, how does air travel affect our health? The authors explain:

“…the main impact of air travel is the inhalation of air with reduced oxygen content in a pressurized environment, resulting in lower circulating oxygen levels in the blood, known as hypobaric hypoxia. Passengers already at high risk of angina, MI, heart failure, or abnormal heart rhythms might be adversely affected by hypoxia.”

Recent studies have shown however that the blood oxygen levels have little or no adverse effects on the circulatory system, certainly not in short-haul flights.

Based o these new findings, here is what the new guidelines has to say:

Patients after heart surgery

What are the travelling restrictions for those who had just a heart surgery? The guidance states it depends on the type of procedure and the risk profile of the patient.

“For post-STEMI and NSTEMI, those at low risk are advised that they can fly three days after their event and those at medium risk can fly after 10 days.”

Those with high-risk profiles should wait a little longer for stabilization. At any rate, the decision to fly should be discussed with the doctor.

Heart patients with pacemakers and other implants

People are wondering how flying can affect their implantable cardioverter defibrillators (ICDs), pacemakers and stents. The guidance states that  in most cases, flying is safe for people wearing these implants.

“After uncomplicated elective PCI, the guidelines state that patients can fly “after two days.” Likewise, patients with pacemakers implanted are advised they can fly after two days, unless they have suffered pneumothorax, in which case they should wait until two weeks after it has fully healed. The same advice applies to those with ICDs, with the added recommendation that they should not fly after the ICD has delivered a shock until the condition is considered stable.applies to those with ICDs, with the added recommendation that they should not fly after the ICD has delivered a shock until the condition is considered stable.

Deep vein thrombosis (DVT) and venous thromboembolism (VTE)

Many studies have shown that the risk for DVT and VTE increase when flying for long periods of time such as during a long-haul flight. However, the same increased risk applies when travelling by car, bus, or train. The absolute risk for DVT among healthy individuals is 1 in 6000 for a long-haul flight (e.g. more than 4 hours).

“Even those at high risk—those who have already had a DVT, recent surgery lasting more than 30 minutes, or known thrombophilia or are pregnant or obese (BMI>30 kg/m2)—can still fly, provided they consume plenty of fluids, exclude caffeine and alcohol, wear compression stockings, and take a low-molecular-weight heparin.[as blood thinner]..”

Warning: Aspirin as a blood thinner during flying is not recommended!