Proposing a new system for cardiovascular risk assessment in pilots

Current cardiovascular risk screening approach in airline pilots in New Zealand (NZ) does not fully achieve the goal of identifying silent cardiovascular disease (CVD) before it causes sudden incapacitating symptoms. Moreover, approaches to investigate excessive cardiovascular risk relied heavily on exercise electrocardiography as a diagnostic test, and were sub-optimal to either detect disease, or to protect pilots from unnecessary invasive procedures. This paper recommends a new approach in assessing CVD in asymptomatic pilots in NZ. The assessment of a 5-year cardiovascular risk score using NZ cardiovascular risk charts as currently adopted will still be the first step of the screening process. The new approach is that asymptomatic pilots with 5-year CVD risk of 5-10% and 10-15% will be referred for coronary artery calcium scoring. No further cardiovascular investigations will be required if the calcium score is <400. Those with a calcium score between 100 and 399 will receive drug and/or lifestyle interventions. Pilots with a calcium score of ?400 will proceed to a stress myocardial perfusion imaging or a coronary computed tomography angiography. Those with a normal result will not undertake further examination and will receive lifestyle and/or drug interventions. If an abnormal result is found, the pilots will undergo a coronary angiography, and a definitive treatment such as percutaneous coronary intervention might be recommended. After consideration of the risks and benefits of cardiac tests involved, the proposed new system appears to be reasonable and feasible to be implemented in the cardiovascular risk assessment of asymptomatic pilots. Keywords: Assessment tool, CACS, occupational group, risk stratification, aviation