The British Cardiovascular Society has published advice about the risks of flying for passengers with recognised cardiovascular disease.  This was produced in response to the House of Lords Science and Technology Committee report on Air Travel and Health, which suggested that specialist cardiology guidance would be of assistance when determining the risks of passenger flight for those with cardiovascular disorders.  The advice is based on evidence from research, where available, and on the opinion of experts, where no evidence exists.

According to a ‘Best Treatments’ summary of the advice, the following people may fly without specialist treatment:

• People with mild angina 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.

Guidance is given on the appropriate time that should pass between having cardiac procedures (e.g. pacemaker fitted) or suffering acute events (e.g. acute coronary syndromes) and flying.  Additionally the guidance discusses the risk of DVT and cases where prophylactic measures are recommended, with the following overall recommendations:

• Low risk (no history of DVT/VTE, no recent surgery, no other known risk factor) – non-pharmacological measures (e.g. keep mobile, well hydrated, avoid alcohol, avoid smoking and caffeine)

• Moderate risk (previous history of DVT/VTE, recent surgery lasting >30 min in the past 2 months but not in the last 4 weeks, known thrombophilia, pregnancy, BMI >30 kg/m2) – non-pharmacological measures and compression stockings

• High risk (recent [within 4 weeks] surgery under general anaesthesia lasting >30 min, previous DVT with known additional risk factor(s) including known cancer) – as per moderate and consider low molecular weight heparin (subcutaneous enoxoparin 40mg on the morning of the flight and on the following day)

Warfarin is protective and should be continued.  Further advice should be sought for patients with a plaster cast, those who have suffered a DVT/VTE within the previous two weeks.  The guidance notes that aspiring is not currently recommended in this context for DVT/VTE prophylaxis.