What are Travelling Recommendations for Patients With Heart Failure?

Health-care providers are frequently approached by patients for advice on how to prepare for travel or to determine whether travelling is advisable at all. General practitioners can provide information to healthy individuals but specialist consultation is of benefit for patients with underlying illnesses such as heart failure. Although some guidance has been published a systematic overview of recommendations for patients with HF planning to travel is not yet available.

Therefore, Dr Stephan von Haehling and his team discussed the factors that might increase the risk of HF symptom development, such as local climate, air pollution levels and altitude levels, and provided specific guidance for patients with a cardiac implantable device and those who have undergone major surgery.

About pre-travel, they noted, "Pre-travel risk assessment should involve research into the local climate, air pollution levels, the distance and time for travelling, potential jet lag and altitude."

Regarding En route, they advised, "Patients with HF should avoid volume depletion caused by extended chair rest, low cabin humidity and cooled air, excess alcohol or coffee intake, drugs with diuretic effects, hypoxia or traveller's diarrhoea."

At the destination, they recommend considering drug-induced photosensitivity and the health effects of local foods and beverages.

Following are the Key Guidance Discussed:

• Patients with heart failure (HF) are recommended to schedule a specialist consultation for pre-travel risk assessment 4–6 weeks before departure.
  
• Preparation for travel requires special considerations in patients with HF, including the choice of destination, availability of medical resources and strategies to prevent volume depletion.
• Most patients with HF can travel when medically stable; patients with a ground-level oxygen saturation ≤90% or those in NYHA class III-IV might need an onboard medical oxygen supply.
• All medication and important documents should be stored in carry-on luggage.
• Volume depletion and dehydration are important considerations requiring meticulous attention with regards to medication adjustment and fluid intake.
• Patients with implantable cardiac devices might require extra time at security checkpoints and additional documents; for some patients, remote monitoring of implantable cardiac devices might be useful.

The authors concluded, "Patients should be aware of an increased risk of cardiovascular events during their travels, which can be reduced with meticulous pre-travel risk assessment, physical examination, therapy adjustment and education. Special recommendations are needed for patients after implantation of cardiac rhythm devices or LVADs as well as for patients who have undergone major cardiac surgery."

For further information:

DOI: https://doi.org/10.1038/s41569-021-00643-z