Air Travel in Patients with Acute Coronary Syndromes or Heart Failure: Current Evidence, Guidance and Gaps

BACKGROUND: As more people live with cardiovascular disease, commercial flights increasingly include patients recovering from acute coronary syndrome (ACS) or living with heart failure (HF), who face unique physiological and logistical challenges due to hypobaric hypoxia, reduced pressure, prolonged immobility, and limited onboard medical resources. METHODS: We reviewed current guidelines, observational studies, and registry data to synthesize evidence and define major gaps regarding air travel in patients with ACS or HF. RESULTS: Available data although derived from small, heterogeneous cohorts and different therapeutic eras, suggest that many clinically stable patients after ACS and those with compensated HF (New York Heart Association classes I-III) can generally fly with low short-term event rates when appropriately assessed. The risk may be higher in the very early post-discharge period, with the magnitude of this excess risk remaining poorly defined. No universally accepted waiting period after ACS or HF decompensation is recommended by guidelines although they broadly concordant in emphasizing clinical stability, euvolemia and absence of ongoing ischemia prerequisites for travel, yet these recommendations have not been validated against in-flight outcomes. CONCLUSIONS: Commercial air travel is likely safe for patients with ACS or HF who are clinically stable, but decisions should be individualized and incorporate both patient- and flight-specific factors. Substantial evidence gaps persist, particularly regarding optimal timing after ACS or HF decompensation and the development of aviation-specific risk models. Prospective cohorts and international registries integrating contemporary clinical, airline, and in-flight medical event data are needed to refine guidance and support patient mobility without compromising safety.