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Cardiovascular emergencies in cruise ship passengers
Gian M Novaro1, Howard S Bush, Kenneth R Fromkin
1Department of Cardiology, Cleveland Clinic Florida, Weston, Florida, USA. novarog@ccf.org
Insights
Cardiovascular emergencies, including acute coronary syndrome, occur frequently on cruise ships, often requiring hospitalization and revascularization. Pre-travel medical evaluations and onboard electrocardiograms are recommended for at-risk passengers.
Area of Science:
- Cardiology
- Public Health
- Travel Medicine
Background:
- Millions travel by cruise ship annually, including many elderly individuals with pre-existing cardiovascular disease.
- The clinical characteristics and outcomes of cardiovascular emergencies during cruise ship travel are not well-documented.
- Cardiology consultations are provided to major cruise lines, offering a unique opportunity to study these events.
Purpose of the Study:
- To investigate the incidence, presentation, and outcomes of cardiovascular emergencies occurring during cruise ship voyages.
- To identify key diagnoses, interventions, and mortality rates associated with these onboard medical events.
- To provide recommendations for pre-travel preparation and onboard medical management for passengers with cardiovascular conditions.
Main Methods:
- A prospective registry of cardiology consultations was maintained over a 2-year period.
- One hundred consecutive patients experiencing cardiovascular emergencies were identified and analyzed.
- Data collected included patient demographics, symptoms, diagnoses, treatments, and outcomes, including hospital triage and mortality.
Main Results:
- The study identified 100 patients (mean age 66 years, 76% male) with cardiovascular emergencies.
- The most common symptom was chest pain (50%), and the most frequent diagnosis was acute coronary syndrome (58%).
- Onboard mortality was 3%, with 73% requiring hospital triage; 17 of 25 triaged patients underwent revascularization.
Conclusions:
- Cardiovascular emergencies are common and serious on cruise ships, necessitating prompt medical attention and often hospital transfer.
- A pre-travel medical evaluation is advised for passengers with cardiac history or risk factors.
- Onboard electrocardiogram availability and prompt consultation mechanisms are crucial for managing these events effectively.
Abstract:
More than 10 million people, many elderly and likely to harbor cardiovascular (CV) disease, embark on cruise ship travel worldwide every year. The clinical presentation and outcome of CV emergencies presenting during cruise ship travel remain largely unknown. Our department provides contracted cardiology consultations to several large cruise lines. We prospectively maintained a registry of all such consultations during a 2-year period. One hundred consecutive patients were identified (age 66 +/- 14 years, range 18 to 90, 76% men). The most common symptom was chest pain (50%). The most common diagnosis was acute coronary syndrome (58%; ST elevation in 21% and non-ST elevation in 37%). On-board mortality was 3%. Overall, 73% of patients required hospital triage. Of the 25 patients triaged to our institution, 17 underwent a revascularization procedure. One patient died. Ten percent of patients had cardiac symptoms in the days or weeks before boarding; all required hospital triage. Access to a baseline electrocardiogram would have been clinically useful in 23% of cases. In conclusion, CV emergencies, such as acute coronary syndrome and heart failure, are not uncommon on cruise ships. They are often serious, requiring hospital triage and coronary revascularization. A pretravel medical evaluation is recommended for passengers with a cardiac history or a high-risk profile. Passengers should be encouraged to bring a copy of their electrocardiogram on board if abnormal. Cruise lines should establish mechanisms for prompt consultation and triage.
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