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 "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: http://bit.ly/1qnoEnE Air Medical Journal, September-October
2014.
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