CHFers and Flying 

March 11, 2000 - Jon - I asked my own CHF specialist about CHFers flying in commercial airliners (planes). He said that he never restricts patients from flying commercially who are comfortable with mild activity.

CHFers and Flying 

March 20, 2000 - I asked another CHF specialist I know the same question. Here's what he said: Modern airplanes are pressurized. There are not problems with oxygen content in the air when one flies in them. In general, one must consider the "stress" of the journey in relation to the person's heart condition. If his heart failure is not stable and well controlled, the patient should not take any sort of non-local trip. If the person has an arrhythmia which is not currently well controlled, again, no trip be should be taken.
     What is really important in a stable CHF patient is how long the flight lasts. This determines how long the person will have to sit. Prolonged sitting may increase the chance of blood clots in your legs.
     You should also consider any interference with therapy. For instance, if you take diuretics (like Lasix) you may have to get up and go during the trip and this convinces many people with CHF not to take their diuretic that day, which is not good. Airline food is usually high sodium too!
     I usually discuss with my patients their planned journey individually. I think it's wise for each patient to discuss any flight or trip with their doctor or CHF doctor first.

Tips On Traveling With CHF 

Before you go -

While on your trip If you need medical assistance in a foreign country, your hotel can put you in touch with an English-speaking doctor who may even come to your room to see you. Foreign resort areas and cities often have clinics specializing in treating English-speaking tourists. Often the standard of care given by these clinics is good.
     Cruise ships have infirmaries staffed by nurses and doctors. However, the quality of care is uneven. Sometime the ship's doctor is a retired physician who is given a free cruise in exchange for his services. On the newer and larger ships, the medical facilities and treatment are more likely to be professional than on smaller ships.
     Passengers who are deemed seriously ill are usually removed from the ship at the first port of call - whether they want to be or not. You may find yourself in a hospital in Trinidad while your ship sails off into the sunset. In such a situation, good trip cancellation insurance is important because it will pay to get you home!

Trip cancellation insurance Before deciding whether you need trip cancellation insurance and how much, figure out how much of your trip's cost would be non-refundable if you had to cancel. Also figure the approximate cost of an unscheduled return. Tour and cruise operators impose cancellation penalties, which increase as the departure date gets closer.
     Cancellation penalties reach 100% of the total price at some point. The operators will show no mercy. You will not get a refund without cancellation insurance no matter how pitiful your story is. Most airline tickets are also non-refundable these days. Illness is no excuse - only death. If you do not use your ticket, however, all is not lost. The ticket will keep its value minus a penalty of $75 for up to 2 years. During that period you can apply the remaining value of the ticket towards another ticket for yourself on the same airline.
     Trip cancellation insurance is available from companies such as Travel Insured International, TravelGuard, and Access America. The travel agent arranging your trip can give you information and application forms, or you can purchase insurance directly from these companies. Cruise lines and tour operators offer trip cancellation insurance along with their product, sometimes at a lower cost. It is very important to fully understand what the insurance really covers before buying it. Trip cancellation insurance should cover:

  1. cancellations due to illness or death of the insured, his or her immediate family members, and traveling companions
  2. cancellations due to some other disasters, such as your house burning down, jury duty, or missing your tour or cruise due to a flat tire on the way to the airport
  3. if your trip is interrupted due to a covered reason, the insurance will pay for additional costs incurred in returning home, and will reimburse you for the unused parts of your trip
  4. if you cannot be properly treated medically or you become ill or injured, the insurance will pay to evacuate you to the nearest appropriate medical facility

CHFers must purchase trip cancellation insurance that covers pre-existing conditions. These days, most insurance policies will cover pre-existing conditions if they are purchased within a week or two of the initial deposit or payment on a trip.
     The cost of such insurance varies, depending on the company. It usually costs about $7.00 per $100 of coverage. This may seem high, but lots of legitimate cancellations occur and the insurance companies have to pay out a lot of money for claims. Supplemental medical and baggage coverage can also be purchased at additional cost.
     Before deciding whether to purchase medical insurance to cover you on your trip, check with your insurance provider. Medicare does not cover you outside the USA, but many supplemental insurances might. If you are treated abroad and your insurance will cover it, you have to pay the provider for your treatment at the time of treatment, then submit a claim for reimbursement when your return home.
     Before buying baggage insurance, check your homeowner's policy! It probably covers you for lost or stolen baggage after a deductible amount. The airlines do have limited liability for lost and damaged baggage, but it is small. It is best not to take anything of value on trips. After all, who are you trying to impress - people you don't know and will never see again?
     Shopping is a favorite tourist activity. However, you should restrict your buying to items you can carry back in your hand-carried luggage. Checked bags are often broken into in transit, and items of value are stolen. You can have your purchases shipped to you by the store where you bought them, but be absolutely certain you are dealing with a company that has a spotless reputation. Your purchases might never arrive or may not be exactly what you bought, or they might arrive damaged. To add insult to injury, you may see the same item on sale at a local department store for half the price you paid abroad.
     Trip insurance is very complex. It is best to talk about it with an experienced travel agent who can advise you on how much and what coverage is best for you.

For Seniors, age 62 and up Most airline tickets are non-refundable and have to be paid for within 24 hours after making a reservation. Seniors have a great alternative in the form of senior coupon booklets offered by most major U.S. airlines. The booklets cost about $600 including tax. Each booklet contains 4 coupons, each good for a one way trip anywhere in the continental US or to Puerto Rico, the US Virgin Islands, or Canada. The coupons must be exchanged for tickets within one year of buying the booklet but are fully refundable until the tickets are actually issued. The coupons are non-transferable.
     The beauty of these booklets is that they provide a great deal of flexibility with little risk. You can make reservations for travel using these coupons way in advance. The reservations can be changed or cancelled at will without any penalty. The only rule is that the reservations must be made at least 2 weeks before travel. However, they can be cancelled up until the last minute! The senior coupons can also be used for travel to Alaska and Hawaii but it takes 4 coupons - the entire booklet - for a round trip to those destinations. This usually costs less than the going rate.
     Although the senior coupon books are restricted to people age 62 and over, USAirways allows one exception. A senior may use the coupons for an accompanying grandchild under 12 years of age. For example, a grandparent in Seattle can purchase a coupon booklet for just under $600 and use the booklet for air tickets to Orlando to take an under-12 grandchild to Disney World.
     If you are traveling to Europe, and want a refundable fare, use British Airways if possible. British Airways' fares between the USA and Europe are fully refundable to seniors 60 or older. This "refundability" also applies to one companion of any age traveling with the senior. After all, every senior needs to bring a spry young thing to help them on and off the airplanes. ;-)

Questions? I will be glad to answer any questions related to the above topics - Hedy K., Travel Consultant -

Low Altitude and Exercise In CHF 

February, 1999 - Patients with chronic heart failure (CHF) have reduced oxygen delivery to working muscles. The Dead Sea is the lowest site on earth and has a naturally rich oxygen level, low humidity, and high air pressure. We studied the effects of descending to the Dead Sea on CHFers.
     Twelve patients with CHF and 4 same-age healthy controls had echocardiograms at rest as well as treadmill stress tests - in Haifa at 130 meters above sea level; and again 3 days after descending to the Dead Sea at 402 meters below sea level.
     Significant test differences at the Dead Sea were seen. Time on treadmill increased from 612 to 672 seconds; the Borg exertion-comfort scale decreased by 1 to 2 grades; and oxygen saturation increased by 3% throughout exercise. Systolic blood pressure went down by 9mmHg at rest and went up by 14mmHg at peak exercise at the Dead Sea in CHF patients.
     Cardiac output at rest increased by 300ml/minute. Maximum oxygen consumption (Vo2max) increased by 126ml/min and even more in patients with severe exercise-induced oxygen desaturations.
     So, descending to the low altitude, rich oxygen area of the Dead Sea very much improved short-term exercise performance due to better oxygenation in CHF patients.
Title: Effects of low altitude on exercise performance in patients with congestive heart failure after healing of acute myocardial infarction
Authors: Abinader EG, Sharif DS, Goldhammer E
Source: Am J Cardiol 1999 Feb 1;83(3):383-7
PMID: 10072228, UI: 99170444

Flying, Altitude and CHF 

April, 1998 - Being at high altitude stimulates the nervous system due to hypoxia - not enough oxygen in the body's tissues. Physical activity at high altitude aggravates this condition and can increase heart rate and raise blood pressure; So the heart's workload, its oxygen consumption, and need for blood are increased.
     It is during the first 4 days of exposure to moderate or high altitude that heart patients are at greatest risk. Gradually increasing altitude, limiting activity at first, physical conditioning before increasing altitude, and strict blood pressure control should help reduce risk.
     At altitudes of 2500 to 3000 meters or lower, a heart patient with no symptoms and who does not get symptoms when exercising, with an EF of 50% or more, is at very low risk. High risk coronary patients should be carefully examined and precautions should be tighter. Left and right heart function, and pulmonary artery pressure are the most helpful measurements for evaluating patients with non-ischemic heart disease who plan to go to higher altitudes.
     When advising patients who want to fly in commercial aircraft, it is important to know that a commercial plane's atmospheric pressure approaches the equivalent of 1500 to 2400 meters on land. Propeller-driven planes are rarely pressurized but usually fly at altitudes below 3300 meters. Patients with the following characteristics should not travel by air except with caution:

Title: High altitude stay and air travel in coronary heart disease
Authors: Allemann Y, Saner H, Meier B
Source: Schweiz Med Wochenschr 1998 Apr 25;128(17):671-8
PMID: 9622840, UI: 98286043


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