People living with Heart Failure (HF) are more likely to suffer from sudden cardiovascular events especially during travel. But with a little planning, it is possible for persons living with heart failure to travel.
Here are travel recommendations to ease the anxiety and reduce the risk of adversities for all patients with HF.
Consult your Cardiologist for a health and travel assessment at least 4-6 weeks before date of travel
Before selecting the travel destination, factor in the following:
- Travel time: Longer travel time can increase a patient’s risk of developing health related complications like clots or DVTs (deep vein thrombosis).
- Weather/ season of destination: if extreme or vastly different from own place of residence can increase health risks. Colder climates can cause decompensation of Heart Failure; vitamin D deficiency in winter is also linked to worsening HF. Tropical and hot climates can cause dehydration and heat strokes. Patients are advised to restrain from strenuous activities that can cause excessive sweating and to prevent traveller’s diarrhoea.
- Air pollution levels can affect cardiovascular performance, and highly polluted areas should be avoided
- Prevent altitude sickness. If it does happen, quickly identify and address
- Availability of medical facilities such as Cardiac ready hospitals, ERs (emergency rooms) and pharmacies.
- Mandatory immunizations may depend on the destination. HF patients are advised vaccines for pneumococcal disease, influenza and COVID-19.
Carry your last prescription along with sufficient medications (with extra for unforeseen delays) in your hand baggage.
Carry your insurance card, travel medical insurance and contact list of your doctors. Plan for emergencies.
If you have an implantable cardiac device, carry medical documents to be presented during security checks.
Take measurements to prevent volume depletion. Watch your fluid intake, signs of dehydration as this may worsen your symptoms of heart failure.
Patients with oxygen saturation ≤90% or those in NYHA class III–IV might need an on-board medical oxygen supply if traveling by air. Supplemental Oxygen might be useful for patients who are very symptomatic.
Avoid stressors, don’t plan a very hectic trip. Pre-plan help with luggage, accommodation and transport, wheelchair access if required etc.
Related Reading: Travel Tips For Persons With Diabetes
Dehydration and fluid intake
Patients with HF should take special care to avoid any drastic change in their fluid volumes, as this can directly affect their cardiac and renal functioning and lead to worsening of their HF. So they must pay attention to weather changes, foods with added salt, traveller’s diarrhoea, altitude or motion sickness or any other factors that may lower their bodily fluids. See list below on factors that contribute to volume depletion during travel.
- Traveller’s Diarrhoea: Water loss
- Hot climate: Water loss through sweating
- Chair rest: Blood pooling and greater loss of fluid into the interstitial space in the legs
- Excess caffeine (coffee, carbonated drinks) and alcohol intake: Beverages with diuretic effect
| Signs and symptoms of volume depletion and dehydration-associated electrolyte or acid–base imbalance include fatigue, confusion, exercise intolerance, weight loss, increase in heart rate, muscle cramps, weakness, postural dizziness, abdominal pain, low urine volume, low blood pressure etc.. |
Patients are hence advised to see their doctors for a full assessment before any travel. The assessment may include the following:
- Check on all current medications and present state of health.
- Some tests may be prescribed based on status of last tests and present health condition.
- Check on immunization history and administration of any pending vaccines.
- If there any implanted devices, remote monitoring to be set up or checked.
- History of any adverse health effects/episodes during past travels.
- Information of destination, time and mode of travel, planned activities such as big get-togethers, walking treks, camping, adventure sports etc.
- Review of what to carry in medical kit and documentation.
- Patient education on food and water safety, avoidance of excessive alcoholic and caffeinated drinks which are natural diuretics.
- How to recognise and correct volume depletion; and whether there is any need for temporary discontinuation of certain HF medications. If the patient is on diuretics , then they may be stopped to avoid further loss of fluids from the body. If the blood pressure has dropped, then BP pills should be discontinued will BP levels return to normal.
- How to prevent DVTs or venous clots during travel. The risk is significantly higher in patients with HF and more than 4 hours long in air or road transport. Your doctor will guide you on prevention methods such as compression stockings, increasing mobility, exercises and adequate hydration.
Issued as part of the public education series by Boehringer Ingelheim India and PatientsEngage
References:
von Haehling, S., Birner, C., Dworatzek, E. et al. Travelling with heart failure: risk assessment and practical recommendations. Nat Rev Cardiol 19, 302–313 (2022). https://doi.org/10.1038/s41569-021-00643-z
Travel and heart disease (2021) www.heart.org. Available at: https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/travel-and-heart-disease
