Flying home by commercial jet may be safe after heart attack: study

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[September 23, 2014]  By Roxanne Nelson

NEW YORK (Reuters Health) - People who have a heart attack while traveling abroad may be able to safely fly home on a regular commercial flight, according to a new study published in the Air Medical Journal.

"There is very little useful information in the literature, to guide recommendations for helping patients and family members who have a medical problem abroad and then ask when it is safe to come home," Dr. William Brady, the study’s senior author, told Reuters Health.

"Patients with an uncomplicated heart attack were usually able to make it home in about 10 days, flying on a regular commercial airline," he added.

Those who only had heart-related chest pain were usually able to travel even sooner, he said.

Heart attack patients who had complications while hospitalized traveled home around 15 days after the attack, on average.

The vast majority of patients in the study did not have any problems in flight. However, Brady emphasizes, patients need to be stable before attempting to return home on a commercial airline, and this can only be determined by the doctor caring for the patient in the foreign country.

"If you had complications, it may be longer before you can return home, or you may need a medical transport, if you are in a situation where you can't get appropriate care," he said.

Brady, a professor of emergency medicine and internal medicine at the University of Virginia, is also affiliated with Allianz Global Assistance, a travel insurance company. In this study, he and his colleagues looked at data from 288 patients who were enrolled in an Allianz travel-based medical assistance program and had experienced an acute coronary syndrome, or ACS, while traveling abroad between 2006 and 2011.

ACS refers to any condition brought on by sudden, reduced blood flow to the heart.

A little over half the patients had suffered a heart attack, while the others had “unstable angina,” a condition with unpredictable heart-related chest pain. About two-thirds had received some kind of reperfusion therapy (either percutaneous coronary interventions or heart surgery).

About three-quarters of the patients did travel home with a medical escort. About one in every six used oxygen during the flight.

People who might need oxygen during a flight must bring their own supply with them, with permission in advance from the airline.

Altogether, only four patients, or less than two percent, had problems during the flight. One reported anxiety, one had abnormal heart rhythms, one had chest pain, and one had sweating and dizziness.

Nine patients (three percent) died within two weeks of returning home. Six were among those who'd initially had complications after a heart attack. None of the patients with problems during the flight died during the study's follow-up period.

Airline travel can cause problems for ACS patients, write the authors, and these include a reduced supply of oxygen, travel-related anxiety, and extremely limited access to medical care while in flight.

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This can be especially concerning when on long trans-Atlantic or trans-Pacific flights, explained Brady. "There is no ability to land anywhere, and if there's a medical problem on board, there is really nothing that can be done even if there are healthcare professionals on the plane."

After returning the U.S., 41 percent of the patients in this study were able to go directly home and did not need to be readmitted to a hospital.

But Dr. Robert O. Bonow, a professor of medicine at Northwestern University Feinberg School of Medicine in Chicago, cautions that this was a small study and may not be applicable to the general public.

"All patients were under the shelter of a travel-based medical assistance program and most had medical assistance on the flight home, so this may not be so safe for the average traveler," said Bonow, who is also past president of the American Heart Association and was not involved in the research. "We have no idea what the outcome has been for the thousands of travelers who have heart attacks overseas without this pre-arranged safety net."

But still, he added, the study provides some good news, as it seems that airline travel can be safe for some patients soon after a heart attack. Individual circumstances, however, always have to be considered.

"There may be extenuating circumstances where you have to travel sooner rather than later," he said. "And patients can also check with their doctors back home, before making a decision to fly."

Of course, Brady warns, prevention may be the best option. Healthcare systems in other parts of the world can be very different from those in North America, he noted, and patients with health conditions need to take a number of factors into consideration before they travel abroad.

"They need to ask themselves if it is appropriate for them to be traveling abroad, and understand what resources are available," he said.

SOURCE: Air Medical Journal, September-October 2014.

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