Abstract
Cardiovascular disease (CVD) is the leading cause of death among international travellers. Practitioner knowledge of the effects of CVD on international travel is imperative in order to promote a healthy travel experience. This review aimed to explore the available literature on this topic. The PubMed database was accessed to source relevant literature using combinations of relevant keywords as search terms. Articles were restricted to those published in the English language through March 2019. Of 1726 article records retrieved, 73 relevant papers were examined carefully. The results of this narrative review are related to multiple aspects of CVD and travel. The pre-travel consultation should address issues regarding vaccinations, travel insurance, anticoagulation, and medical devices. Additional vaccines to be discussed include influenza, pneumococcal, and hepatitis B. Patients with CVD should be advised of the need to carry a copy of their ECG, prescription(s), and pacemaker manufacturer’s card. Knowledge of the location overseas of automated external defibrillators and awareness of health risks associated with strenuous adventure activities are important for CVD travellers. Medical tourism for patients with CVD is briefly considered. Space tourism is an emerging category of extreme international travel that requires specialized pre-travel preparation. This narrative review article highlights the gaps in the travel medicine literature in relation to CVD. A strong evidence base for most recommendations is lacking. Future scholarly efforts are warranted to facilitate more robust travel recommendations for CVD patients. No qualitative studies to date have described the experiences of international travellers with CVD.
Highlights
International tourism, as a global economic sector, has experienced significant growth in recent decades
According to the World Tourism Organization, there were over 1.3 billion international tourist arrivals in 2017, and this figure is expected to reach 1.8 billion by 2030.1 Parallel to the growth in international travel is an increase in the incidence and prevalence of cardiovascular disease (CVD), which remains the leading cause of death globally.[2]
Combinations of the following keywords were used as search terms: ‘cardiovascular’, ‘cardiac’, ‘heart’, ‘travel’, ‘travelling’, ‘air travel’, ‘congenital heart disease’, ‘stroke’, ‘cardiac device’, ‘airport’, ‘pacemaker’, ‘automated external defibrillator’, ‘microgravity’, ‘sport’, ‘adventure activity’, ‘adventure sports’, ‘diving’, ‘medical tourism’, ‘travel insurance’, ‘travellers’, ‘abroad’, ‘airplane’, ‘heart transplant’, and ‘medication’
Summary
International tourism, as a global economic sector, has experienced significant growth in recent decades. The effect of air travel on the cardiovascular system has been well studied.[6] the extent to which CVD affects the experiences of international travellers has not previously been determined. People with CVD may find their travel experiences stressful owing to various difficulties related to their disease and its pharmacotherapy. These could range from issues encountered in the airport to limited participation in activities abroad owing to the fear of unpredictable medical events. There is a lack of guidance for travel medicine practitioners and specialist cardiologists when confronted
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