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Cardiovascular risk in high-hazard occupations: the role of occupational cardiology
Iain T Parsons1,2, Edward D Nicol1,3,4, David Holdsworth1
1Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
Insights
Occupational cardiology addresses cardiovascular disease (CVD) risks in high-hazard jobs. Further research is needed for evidence-based risk management in demanding professions.
Area of Science:
- Occupational Medicine
- Cardiology
- Environmental Health
Background:
- Cardiovascular disease (CVD) is a significant concern for working individuals, particularly in high-hazard occupations where incapacitation can have severe consequences.
- Occupational cardiology integrates cardiology with specialized prevention and risk management tailored to employment conditions.
- Pre-employment and periodic medical screenings are crucial for identifying CVD risks in high-hazard roles, potentially leading to occupational restrictions.
Purpose of the Study:
- To review existing evidence on occupational cardiology in high-hazard professions, including aviation, space, diving, emergency services, transportation, and military roles.
- To focus on environmental risks, screening protocols, surveillance strategies, and risk management for preventing CVD-related events in these occupations.
- To highlight the need for further research due to a current lack of consensus and contemporary evidence in the field.
Main Methods:
- Literature review of occupational cardiology principles and practices.
- Analysis of environmental risks pertinent to specific high-hazard occupations.
- Examination of current screening, surveillance, and risk management strategies for CVD.
Main Results:
- Occupational cardiology requires a multidisciplinary approach, combining general cardiology with environmental and occupational medicine.
- High-hazard occupations present unique cardiovascular challenges requiring specialized medical attention.
- Current evidence is insufficient, indicating a need for more research to establish consensus and best practices.
Conclusions:
- Occupational cardiology is essential for managing cardiovascular health in high-risk professions.
- Individualized, evidence-based risk stratification and treatment plans are necessary.
- Further research is critical to address the current lack of consensus and advance the field of occupational cardiology.
Abstract:
Work is beneficial for health, but many individuals develop cardiovascular disease (CVD) during their working lives. Occupational cardiology is an emerging field that combines traditional cardiology sub-specialisms with prevention and risk management unique to specific employment characteristics and conditions. In some occupational settings incapacitation through CVD has the potential to be catastrophic due to the nature of work and/or the working environment. These are often termed 'hazardous' or 'high-hazard' occupations. Consequently, many organizations that employ individuals in high-hazard roles undertake pre-employment medicals and periodic medical examinations to screen for CVD. The identification of CVD that exceeds predefined employer (or regulatory body) risk thresholds can result in occupational restriction, or disqualification, which may be temporary or permanent. This article will review the evidence related to occupational cardiology for several high-hazard occupations related to aviation and space, diving, high altitude, emergency workers, commercial transportation, and the military. The article will focus on environmental risk, screening, surveillance, and risk management for the prevention of events precipitated by CVD. Occupational cardiology is a challenging field that requires a broad understanding of general cardiology, environmental, and occupational medicine principles. There is a current lack of consensus and contemporary evidence which requires further research. Provision of evidence-based, but individualized, risk stratification and treatment plans is required from specialists that understand the complex interaction between work and the cardiovascular system. There is a current lack of consensus and contemporary evidence in occupational cardiology and further research is required.
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