Cardiac rehabilitation : application in aviation cardiology

In aviation cardiology strict demands are imposed on the health status of aircrew returning to work after coronary heart disease (CHD): i.e. no signs of active CHD, high physical work capacity, normal or near-normal findings on coronary angiography, echocardiography, ECG-monitoring and optimal management of risk factors. Aircrew suffering from CHD should be enrolled in comprehensive cardiac rehabilitation including smoking cessation, physical training, stress management, dietary and vocational counselling. Risk stratification early after the coronary event will identify low-risk patients who may be able to resume multi-pilot flight operations and those who are less likely to fulfil the criteria for recertification. In low-risk patients, participation in a 3-month programme tailored to the specific needs of aviation personnel is recommended. The remaining patients should be offered a standard rehabilitation programme. This may improve both the long-term medical outcome and the psychosocial prognosis even if return to flight operations is not conceivable.