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Does cardiovascular risk assessment of pilots detect cardiovascular disease and prevent sudden clinical presentations?

dr. I MD. ADY WIRAWAN, S.Ked., MPH, Ph.D, I MD. ADY WIRAWAN (2012) Does cardiovascular risk assessment of pilots detect cardiovascular disease and prevent sudden clinical presentations? Aviation, Space, and Environmental Medicine, 83, No. ISSN 0095-6562

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Abstract

INTRODUCTION: Due to the potential for cardiovascular disease (CVD) to cause pilot incapacitation, screening of pilot cardiovascular risk to detect and treat disease and prevent sudden onset events is current practice. In New Zealand, the Civil Aviation Authority has routinely applied an adjusted Framingham-based cardiovascular risk prediction score to do this. This study examined cardiovascular disease (CVD) events occurring in a commercial pilot population, and examined the sensitivity and specifi city of the current cardiovascular risk score in predicting these events. METHODS: A matched case-control design was applied to assess the association of 5-year cardiovascular risk score and cardiovascular events in an Oceania based airline pilots. Cases were pilots with cardiovascular events as recorded on their medical records. Each case was age and gender matched with 4 controls that were randomly selected from the pilot population. Five-year retrospective evaluations were conducted to collect data before the events. RESULTS: Fifteen cases of cardiovascular events were identifi ed over a 16-year study period, 9 (60%) of which were sudden clinical presentations, and only 6 (40%) of which were detected using cardiovascular screening. Eight cases (53%) and 16 controls (27%) had a 5-year risk of 􀁴10-15%. Almost half of the events (7/15) occurred in pilots whose highest 5-year risk was in the 5-10% range. Cases were nearly 4 times more likely to have highest 5-year risk score of 􀁴10-15% than controls (OR = 3.91, 95% CI 1.04-16.35, p = 0.04). The accuracy of the highest risk score were moderate (AUC = 0.723, 95% CI 0.583-0.863). The cut-off point of 10% is valid with specifi city of 0.73 but low sensitivity (0.53). DISCUSSION: Despite a valid and appropriate cut-off point, the tool had low sensitivity and was unable to predict almost half of the cardiovascular events. The majority of CVD events remain sudden onset clinical presentations.

Item Type: Article
Uncontrolled Keywords: cardiovascular epidemiology, cardiovascular risk
Subjects: L Education > L Education (General)
Divisions: Faculty of Law, Arts and Social Sciences > School of Education
Depositing User: Mr. Repository Admin
Date Deposited: 07 Jun 2016 21:58
Last Modified: 21 Jun 2016 05:58
URI: http://erepo.unud.ac.id/id/eprint/7933

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