The clinical, occupational and financial outcomes associated with a bespoke specialist clinic for military aircrew—a cohort study

Pavitt, Annabelle J; Pavitt, Christopher W; Harron, Katie; Jones, Michael; Timperley, Andrew C.; Reid, Alastair; McLoughlin, David C; d’Arcy, Joanna; Nicol, Edward

doi:10.1093/qjmed/hcv184

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…Referrals were made from a UK military aviation medicine population of ~ 8000 personnel. Of the 1025 medical referrals, 558 (54%) were made for evaluation of suspected cardiovascular disease [15]. Referral was by primary healthcare physicians or occupational physicians, the majority of whom are trained aeromedical examiners (AMEs).…”

Section: Resultsmentioning

confidence: 99%

“…We included all consecutive cases in which a CMR was performed in addition to standard of care investigations at the Royal Air Force (RAF) Aviation Medicine Consultation Service (AMCS). AMCS, established in 2011, is the referral centre for all clinical occupational queries relating to aircrew in the British Armed Forces [15]. Standard care included history and examination; ETT; 24-h Holter-monitor and TTE in all cases.…”

Section: Methodsmentioning

confidence: 99%

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Cardiac MRI improves cardiovascular risk stratification in hazardous occupations

Holdsworth

Parsons

Chamley

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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Background The benefit of cardiovascular magnetic resonance Imaging (CMR) in assessing occupational risk is unknown. Pilots undergo frequent medical assessment for occult disease, which threatens incapacitation or distraction during flight. ECG and examination anomalies often lead to lengthy restriction, pending full investigation. CMR provides a sensitive, specific assessment of cardiac anatomy, tissue characterisation, perfusion defects and myocardial viability. We sought to determine if CMR, when added to standard care, would alter occupational outcome. Methods A retrospective review was conducted of all personnel attending the RAF Aviation Medicine Consultation Service (AMCS) for assessment of a cardiac anomaly, over a 2-year period. Those undergoing standard of care (history, examination, exercise ECG, 24 h-Holter and transthoracic echocardiography), and those undergoing a CMR in addition, were identified. The influence of CMR upon the final decision regarding flying restriction was determined by comparing the diagnosis reached with standard of care plus CMR vs. standard of care alone. Results Of the ~ 8000 UK military aircrew, 558 personnel were seen for cardiovascular assessment. Fifty-two underwent CMR. A normal TTE did not reliably exclude abnormalities subsequently detected by CMR. Addition of CMR resulted in an upgraded occupational status in 62% of those investigated, with 37% returning to unrestricted duties. Only 8% of referrals were undiagnosed following CMR. All these were cases of borderline chamber dilatation and reduction in systolic function in whom diagnostic uncertainty remained between physiological exercise adaptation and early cardiomyopathy. Conclusions CMR increases the likelihood of a definitive diagnosis and of return to flying. This study supports early use of CMR in occupational assessment for high-hazard occupations. Electronic supplementary material The online version of this article (10.1186/s12968-019-0544-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cardiac MRI improves cardiovascular risk stratification in hazardous occupations

Holdsworth

Parsons

Chamley

et al. 2019

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

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“…This is predominantly for economic reasons and reflects the fact that investment in aircrew training often runs into many hundreds of thousands, if not millions, of pounds. 30 There is an understandable reluctance to accept additional risk at the outset of flying training or aircrew licensing; however, in trained aircrew, an ability to protect the substantial investment made in individuals, by restricting the role of trained aircrew, while maintaining flight safety, results in differing standards for applicants and those already licensed.…”

Section: Regulation Of Medical Conditions In Aircrewmentioning

confidence: 99%

An introduction to aviation cardiology

Nicol¹,

Rienks

Gray

et al. 2018

Heart

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The management of cardiovascular disease (CVD) has evolved significantly in the last 20 years; however, the last major publication to address a consensus on the management of CVD in aircrew was published in 1999, following the second European Society of Cardiology conference of aviation cardiology experts. This article outlines an introduction to aviation cardiology and focuses on the broad aviation medicine considerations that are required to manage aircrew appropriately and optimally (both pilots and non-pilot aviation professionals). This and the other articles in this series are born out of a 3 year collaborative working group between international military aviation cardiologists and aviation medicine specialists, many of whom also work with and advise civil aviation authorities, as part of a North Atlantic Treaty Organization (NATO) led initiative to address the occupational ramifications of CVD in aircrew (HFM-251). This article describes the types of aircrew employed in the civil and military aviation profession in the 21st century; the types of aircraft and aviation environment that must be understood when managing aircrew with CVD; the regulatory bodies involved in aircrew licensing and the risk assessment processes that are used in aviation medicine to determine the suitability of aircrew to fly with medical (and specifically cardiovascular) disease; and the ethical, occupational and clinical tensions that exist when managing patients with CVD who are also professional aircrew.

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The clinical, occupational and financial outcomes associated with a bespoke specialist clinic for military aircrew—a cohort study

Abstract: This bespoke service has allowed rapid, occupationally relevant clinical care to be delivered with both time and financial savings. The model may have significant occupational and financial relevance for other environmental and occupational medical organizations.

Cited by 2 publications

References 6 publications

Cardiac MRI improves cardiovascular risk stratification in hazardous occupations

Cardiac MRI improves cardiovascular risk stratification in hazardous occupations

An introduction to aviation cardiology

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