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The risks of heart failure while flying and its consequences

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The risks of heart failure while flying and its consequences

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Long-haul commercial flights are frequently associated with increased health risks, especially for vulnerable individuals suffering from underlying illnesses like heart failure (HF). The purpose of this review is to educate patients with such cardiovascular problems by laying out some useful precautions to take before and during air travel, with specific advice for patients with congestive heart failure, implantable heart devices, and those who have had major heart surgery. We also go over the risk factors for developing HF symptoms on a long-distance flight, such as altitude.

The key points to remember about flying long distances with heart failure:

  • Patients with heart failure are strongly advised to schedule a fit-to-travel assessment consultation between 4 to 6 weeks before departure.
  • Special considerations must be made when preparing for such patients' travel, such as the volume depletion prevention strategies. Indeed, volume depletion and dehydration are important factors to consider when adjusting medications and fluid intake.
  • All medications and important medical information should be kept in carry-on luggage.
  • When medically stable, most heart failure patients can travel safely. Patients with a baseline oxygen saturation of 90% or those with moderate HF may require an on-board medical oxygen supply. Those with severe or decompensated congestive heart failure should avoid flying commercially.
  • Patients with implantable cardiac devices may need special attention when flying long distances. They can fly safely once medically stable.

heart attack patient

FAQ about flying with heart failure

Which patients with heart failure can or cannot fly safely?

Though there is little guidance on travel recommendations for patients with heart failure, it is widely assumed that patients with moderate heart failure who are stable should be able to tolerate travel. Patients with moderated HF are those who are comfortable at rest but experience symptoms of angina, palpitations, dyspnoea, or fatigue after light physical activity.

Who is especially at risk?

When flying long distances, patients with pulmonary arterial disease, cardiac arrhythmia (irregular heart rate), or coronary artery disease (CAD), as well as those who have recently had heart surgery or have an implanted heart device, are at a higher risk of cardiovascular events than the general population.

Can heart failure patients who have undergone surgery fly safely?

People who have had coronary artery bypass graft surgery should avoid flying at least until intrathoracic gas resorption is complete, because gas expands as air pressure decreases with increasing altitude.

Can heart failure patients with implanted heart devices fly safely?

Left ventricular assist devices (LVADs) are increasingly being used as a bridge therapy while patients wait for a heart transplant or as a permanent therapy for end-stage heart failure. Patients in either category can fly if they are medically stable and have completed rehabilitation. Patients with pacemakers and implantable cardioverter defibrillators can fly once they are medically stable.

Which heart failure patients should not fly without medical assistance?

Patients with severe or decompensated congestive heart failure (symptoms occur even when resting/any physical activity increases discomfort) should avoid flying. If travel cannot be avoided, on-board oxygen and medical assistance should be requested.

What are the risks of heart failure while flying?

During air travel, heart failure patients are more likely to experience:

  • stress and anxiety, 
  • cardiac decompensation, 
  • respiratory distress, and 
  • venous thromboembolism (VTE). 

Although stable HF patients can fly, those with acute heart failure syndrome should not fly until they have completely recovered.

Most people with heart disease do not face significant risks from flying. Patients with moderate to severe HF, on the other hand, are more likely to experience negative health effects due to the confined space, low oxygen concentration, dehydration, air pressure, high altitude, and the potential for increased stress associated with air travel. Some of these issues compound each other's effects on the patient’s health.

Confined space

A HF patient's risk of developing blood clots, such as deep vein thrombosis (DVT), pulmonary embolism (PE), or an arterial blood clot in the heart (heart attack) or brain (stroke), may be increased by a prolonged lack of physical activity in a cabin’s confined space, as well as because of dehydration while flying. Your risks are heightened if you have congestive heart failure, CAD, or an implanted heart device, such as an artificial heart valve or a coronary stent. If you have an arrhythmia, a blood clot in your heart can also cause a stroke.

small leg space in airplane

Low oxygen concentration

At high altitudes, the partial pressure of oxygen is slightly lower than at sea level. While this difference is usually insignificant in healthy people, if you have heart disease, the lower oxygen pressure in the cabin can lead to low oxygen saturation levels in your body. This exacerbates the symptoms of pre-existing heart conditions such as heart failure, coronary artery disease, and pulmonary hypertension.


Dehydration caused by high altitudes can affect your blood pressure, exacerbating heart disease. This is especially concerning if you have heart failure, coronary artery disease, or an arrhythmia.

Air Pressure

Gas expansion in the body's cavities can be caused by changes in gas pressure (hypobaric exposure) in an airplane's cabin. Passengers with pre-existing pulmonary issues may not be able to take in the same amount of air as on the ground, which can result in serious lung or heart damage if they are recovering from recent heart surgery.

Stress and anxiety

You may experience an exacerbation of your heart failure, hypertension, or CAD if you are stressed or anxious about travelling or the possibility of unexpected turbulence or medical complications during your flight.

Important: Symptoms of a heart failure during flight include lower leg swelling, chest discomfort, difficulty breathing, racing or pounding heart, and persistent coughing.

What are the consequences of experiencing HF symptoms while flying?

Passengers experiencing the symptoms listed above should notify the flight crew immediately. While flight attendants are trained to recognise serious medical issues, administer first aid, and perform CPR, the medical assistance they can provide is limited. They may be able to  seek assistance from the cabin or other passengers (the chances of flying with a certified cardiologist who will volunteer to help are slim), contact medical professionals on the ground, or request an emergency landing. In extreme cases, if proper medical assistance is not obtained, death may occur.

Commercial aircraft, unlike private air ambulances, are not designed to serve as "flying ICUs." They are not intended to respond to all types of medical emergencies. They may not always be equipped with defibrillators, resuscitation equipment, or oxygen. It is also uncommon for patients to be permitted to bring their own oxygen supply. Oxygen is usually arranged by the airline, which must be notified in advance.

What precautions can heart failure passengers take while flying?

For people with heart failure, healthcare professionals recommend the following pre-travel checklist:

  • Discuss any new symptoms/concerns with your doctor before travelling;
  • Carry an ample supply of all medications, properly labelled and stored in your carry-on luggage;
  • Bring a copy of a normal electrocardiogram (ECG) if you have an irregular heartbeat or a pacemaker;
  • Carry contact information of pacemaker and ICD manufacturers, as well as local representatives in the destination country;
  •  Avoid alcoholic beverages and stay hydrated during your flight.
  • Request aisle seating if you are at risk of deep venous thrombosis. This allows you to walk around and stretch your legs without disturbing other passengers;
  • Travelers over the age of 50 should wear below-the-knee compression stockings when flying for more than eight hours if they have one or more risk factors for DVT, such as congestive heart failure, large varicose veins, obesity, pregnancy, use of oral contraceptives or hormone replacement therapy, or recent major surgery;
  • Consider purchasing medical evacuation insurance if your health insurance does not cover medical evacuation.

Travelling with a medical escort as an additional precaution

A commercial medical escort is a healthcare professional who accompanies the patient on a commercial flight, providing medical assistance and ensuring their comfort. Whether they need to be repatriated to their home country after being hospitalised abroad or need to take an international flight from their home country to a specialised medical facility overseas, our commercial medical escorts can assist HF patients in receiving the medical attention they require during their flight. They are critical care certified professionals and have extensive experience working with patients of all medical conditions.

medical escort

Our commercial medical escort services often include the following all-inclusive benefits:

  • Booking your flight and handling all special assistance needs and medical clearances;
  • Arranging ground transportation from the hospital to your home and vice versa upon landing (bed-to-bed service);
  • Providing ongoing medical care, such as oxygen administration and cardiac monitoring during the flight;
  • Maintaining constant communication with a relative to keep your family updated on your condition before, during, and after the flight.

Chartering an ambulance jet: why is it the safest option for heart failure patients?

Moving heart failure patients by fixed-wing air ambulance over long distances is a quick and easy process that keeps them safe and comfortable. Our ambulance jets save valuable time while providing patients with high-quality care that is typically unavailable on regular flights. There is usually enough space for a family member to accompany the patient on the journey, which reduces their apprehensions.

Patients with heart failure have unique medical requirements that must be met during air medical transport. Our Learjets can be outfitted with all of the medical equipment required to stabilise a patient's condition. Blood pressure monitoring devices, for example, are available on our medical jets to help reduce the severity of their symptoms. In some heart failure patients, medications such as antiplatelet therapy to prevent blood clots or intravenous medication to treat atrial fibrillation can be administered. Extra oxygen will be made available to help with respiratory complications, which are a common symptom of heart failure.

Medical Repatriation UK has extensive experience in transporting heart failure patients via air ambulance. Our medical flight crews are highly specialised healthcare professionals who collaborate to form a mobile intensive care unit in the sky.

Do you have any additional questions?

Please go to our FAQ, if you are interested in learning more about what we have to offer.

Contact us right away for medical repatriation!

Please contact our 24-hour service at any time if you require additional information on air ambulances for heart failure patients or a free non-binding quote. Reach us by: