Recurrent Stroke Risk in Pilots with Atrial Fibrillation

Area of Science:

• Cardiology
• Aerospace Medicine
• Neurology

Background:

• Atrial fibrillation (AF) is a common cardiac arrhythmia with aeromedical disqualification implications.
• Understanding outcomes in aviators with a history of both AF and stroke is crucial for flight safety.
• Existing risk scores may not accurately predict outcomes in specialized populations like pilots.

Purpose of the Study:

• To examine significant outcomes in aviators with a prior history of atrial fibrillation and stroke.
• To evaluate the predictive value of CHA₂DS₂-VASc scores in this specific aviator cohort.
• To determine recurrence rates of major adverse events in pilots with AF and stroke.

Main Methods:

• Retrospective review of 141 pilots examined by the FAA between 2002-2012 with AF history.
• Inclusion criteria: initial stroke or transient ischemic attack (TIA) during the study period.
• Data collected: medical/behavioral history, stroke type, CHA₂DS₂-VASc scores, and recurrent events (stroke, TIA, death).

Main Results:

• 17.7% of pilots experienced a recurrent event over the study period.
• Recurrent event rates at 5 years were 17.3%.
• No statistical difference in CHA₂DS₂-VASc scores was found related to the number of recurrent events.

Conclusions:

• Pilots with AF and stroke history exhibited lower recurrence rates than the general population.
• CHA₂DS₂-VASc scores may not be appropriate for risk stratification in aviation populations.
• Further research is needed to establish accurate risk prediction models for aviators with atrial fibrillation.