Fitness to fly: assessing cardiac disease among Air Force pilots

Abstract Introduction Aviation is a risk activity, particularly in pilots with cardiovascular (CV) disease. The occurrence of acute clinical events during flight may have catastrophic implications, justifying the relevance of cardiologic evaluation in Aviation Medicine. However, the evidence about the impact of CV diseases in this population is scarce. Aim To study the cardiac causes of incapacitation among pilot candidates and pilots of the Portuguese Air Force (PoAF) over a period of 20 years. Methods and results A retrospective analysis of cardiac causes of incapacitation between January 1999 and December 2018 was performed, both in PoAF candidates and pilots. In this period, the overall number of candidates was 2529 and the number of PoAF pilots was 760. Among the candidates, 41% (N=1086) were considered unfit, of which 4% (N=39) due to cardiac causes (all men aged 17-25), namely valvular diseases (N=27) and conduction/heart rhythm disturbances (N=12). Among the pilots, 2% (N=18) were considered unfit, mainly due to cardiac disease (50%; N=9). These pilots considered unfit pilots due to cardiac disease were men with mean age of 47±9 (30-60) years old, all unfit due to acute myocardial infarction, none occurring during flight. Conclusion Cardiac diseases were an uncommon cause of incapacitation among the pilot aviator candidates, but it was the main cause among the pilots of the PoAF during two decades, all due to acute myocardial infarction. Cardiac evaluation in Aviation Medicine is essential, focusing on CV risk stratification and preclinical detection of coronary artery disease.Figure 1