Cardiovascular Risk Assessment in Pilots

Abstract

BACKGROUND: For over 30 yr the global medical community has attempted to define the acceptable cardiovascular risk in pilots. This challenge is compounded by the ever-changing technological and medical landscape of air travel. We aimed to review the existing literature on estimating the risk of pilot cardiovascular incapacitation and determine if the current guidelines are founded in the best available evidence.METHODS: A detailed review of the guidelines and literature that supports them was completed. Relevant articles were identified by review of the source literature of the guidelines and the references of these source documents. All articles referenced were reviewed in full by both authors. Data that informed the existing recommendations were reviewed and compared to available modern data. The results of these findings were incorporated into a formula that allows for the calculation of acceptable pilot cardiovascular risk given any operator-determined set of variables.RESULTS: Among the evidence that informs current guidelines, there exists a need for further updating. A number of assumptions have been made in creating guidelines and these may no longer reflect the current technological or medical aviation environment. Incorporating the identified variables into a formula allows for the calculation of acceptable cardiovascular risk. This formula was tested using past data and reproduced existing results.DISCUSSION: Current guidelines for pilot cardiovascular risk assessment require review by the international aviation medical community. We propose a novel formula that may serve as a template for future guidelines and may be adapted as aviation technology and health data evolve.Mulloy A, Wielgosz A. Cardiovascular risk assessment in pilots. Aerosp Med Hum Perform. 2019; 90(8):730–734.

Trends in Sudden Cardiac Death in Pilots: A Post COVID-19 Challenging Crisis of Global Perspectives (2011-2023) - A Systematic Review and Meta-Analysis

“…By focusing on updated trends, potential risk factors, and preventive measures, we aim to enhance aviation safety and safeguard the lives of those who navigate the skies. The findings of this review will have important implications for aviation regulatory bodies, airlines, and healthcare providers involved in the care of pilots (Mulloy et al, 2019) (20).…”

“…Regular cardiovascular risk assessment, including electrocardiography (ECG) and echocardiography, was found to be effective in identifying pilots at increased risk of SCD (20). Pilots who underwent regular cardiovascular risk assessment had a 40% lower risk of SCD compared to those who did not (RR: 0.6, 95% CI: 0.4-0.9) (19).…”

Endogenous Risk Factors of Cardiovascular Diseases (CVDs) in Military Professionals with a Special Emphasis on Military Pilots

“…For many years the “1% rule”, which states that no pilot should have an annual risk of cardiovascular incapacitation exceeding 1%, has served as a possible standard and is endorsed as the threshold of choice by the International Civil Aviation Organization (ICAO), but the methods of determining the risk to an individual pilot vary by jurisdiction [ 32 ]. The Framingham risk score (FRS) is a common and simple tool used for predicting of the risk of CVD development in next 10 years based on data related to age, gender, total cholesterol, status of diabetes, systolic blood pressure, high-density lipoprotein cholesterol (HDL), and tobacco smoking [ 3 ].…”

“…This framework can be applied to a wide variety of clinical situations [ 37 ]. Mulloy and Wielgosz recently proposed the acceptable annual risk formula, which takes into consideration the unique variables inherent in flight for setting CVD risk in commercial pilots [ 32 ]. Moreover, Holdsworth et al proposed a three-dimensional (3D) risk matrix for practical decision making, where the acceptable clinical event rate is very low, to be used within high-hazard occupational medicine.…”

Cardiodynamic adjustments in skilled civil aircraft pilots while unexpected emergency conditions appeared during a simulated flight within a homemade Airbus A300 cockpit

“…Over the past years there have been several reports concerning civil pilots dead during flight due to serious cardiovascular events [1]. About that, in a group of pilots which were several months banned to fly since covid-19 lockdown and which simulated manoeuvres to takeoff, flying in route and landing, a previous study showed that in route mean arterial blood pressure (MAP) stayed at a mean value of about 104 Torr or 12% higher than expected [2].…”