Cardiovascular screening for pilots, aircrew, and high performance & spaceflight passengers

Heart disease is the #1 cause of disease-related death in pilots & astronauts in the world and coronary artery disease (CAD) is found in 85% of pilot autopsies after fatal accidents [1–3]. Acute cardiovascular incidents in flight crew can result in in-flight emergencies requiring emergency diversion, or at worst a major aircraft accident. When including passengers, emergency landings, to include airport diversion, occur in 1 out of every 604 flights at an average cost of $38,000 and are most commonly caused by cardiovascular processes including myocardial infarction and syncope [4]. Medical flying standards in aviators with coronary artery disease (CAD) are well established by the United States Air Force and other military branches such as the Army, Navy, and Coast Guard as well as the Federal Aviation Administration (FAA), National Aeronautics and Space Administration (NASA), and United States NATO allies. However, CAD screening standards vary widely from one aviation organization to another and are strikingly absent in some. In this article, the authors propose an evidence-based CAD screening algorithm based on published literature from 70 years of aircrew specific cardiac data gathered from nearly 1.3 million studies performed on over 300,000 aircrew. Given the advancement of space flight and the commencement of high performance recreational flight opportunities, there is a new era of passengers that will need baseline medical screening and clearance prior to embarking on their adventures. The following proposed screening and disposition algorithms offer evidence-based models for this need.