Predicting the incidence of recurrent positive exercise stress tests among civilian pilots: a retrospective cohort study

Abstract

Abstract* Background A positive exercise stress test (EST) is common among pilots, and it may indicate a greater risk of coronary artery disease (CAD). This study aimed to determine the incidence of recurrently positive EST and their predictors among civilian pilots in Indonesia. Methods This was a retrospective cohort study among civilian pilots who had the first positive EST test between January 2019 and June 2020 at the Aviation Medical Center, Jakarta. The data were retrieved from medical records. Subjects were included if there were data on subsequent ESTs at 6 and 12 months. Risk factors included total flight hours (TFH) in the last 6 months, license type, aircraft cabin pressurization system, flying limitation such as multicrew, cardiac intervention, age, smoking habit, family history of coronary artery disease, body mass index, blood pressure levels, lipid profile, and fasting blood glucose. Results Eighty-seven pilots were included; 54 of them (62.1%) had recurrent positive ESTs. All subjects were men, and the median age was 51 (range 40-64) years. Independent predictors of recurrent positive ESTs were age 60-65 years (adjusted odds ratio [ORadj]: 5.1, 95% CI: 1.12–23.16, p= 0.035), a TFH of > 275 hours (ORadj 5.1, 95% CI: 1.28–20.65, p= 0.021), and dyslipidemia (ORadj: 4.2 95% CI: 1.468–12.275, p=0.015). Having these three risk factors increased the probability of a recurrent positive EST up to 100%. Conclusion The incidence of recurrently positive ESTs among civilian pilots in Indonesia was high. Airlines may want to implement a more aggressive health policy for the prevention of cardiovascular diseases among their pilots.