TY - JOUR
T1 - Cardiovascular risk assessment in divers
T2 - Toward safer diving
AU - Rienks, Rienk
AU - Buwalda, Mattijn
AU - Bucx, Jeroen
AU - Dubois, Emile
AU - Wingelaar, Thijs
AU - van Hulst, Rob
N1 - Publisher Copyright: Copyright© Undersea and Hyperbaric Medical Society.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Similar to aviation, diving is performed in an environment in which acute incapacitation may lead to a fatal outcome. In aeromedicine, a pilot is considered "unfit to fly" when the cardiovascular event risk exceeds one percent per annum, the so-called 1% rule. In diving no formal limits to cardiovascular risk have been established. Cardiovascular risk of divers can be calculated using the modified Canadian Cardiovascular Society (CCS) Risk of Harm formula: risk of harm (RH: cardiovascular fatality rate per year during diving: number × 10-⁵/divers/year) = time diving (TD: number of dives × 10-⁴) × sudden cardiac incapacitation (SCI: cardiovascular diver event rate per year (number × 10-⁵/year). The SCI and thus the RH are strongly dependent on age. Using the CCS criterion for RH, 5 × 10-⁵ divers/year, and considering an average of 25 dives per year per diver, the calculated maximum acceptable SCI is 2%/year, consistent with current practice for dive medical examinations. If the SCI were to exceed 2%/year, a diver could be considered "unfit to dive," which could particularly benefit older (≥ 50 years) divers, in whom cardiovascular risk factors are often not properly treated. For the prevention of fatal diving accidents due to atherosclerotic cardiovascular disease, a dive medical examination is of limited value for young (≺ 50 years) divers who have no cardiovascular risk factors. Introducing a cardiovascular risk management system for divers may achieve a reduction in fatal diving accidents that result from cardiovascular disease in older divers engaged in both recreational and professional diving.
AB - Similar to aviation, diving is performed in an environment in which acute incapacitation may lead to a fatal outcome. In aeromedicine, a pilot is considered "unfit to fly" when the cardiovascular event risk exceeds one percent per annum, the so-called 1% rule. In diving no formal limits to cardiovascular risk have been established. Cardiovascular risk of divers can be calculated using the modified Canadian Cardiovascular Society (CCS) Risk of Harm formula: risk of harm (RH: cardiovascular fatality rate per year during diving: number × 10-⁵/divers/year) = time diving (TD: number of dives × 10-⁴) × sudden cardiac incapacitation (SCI: cardiovascular diver event rate per year (number × 10-⁵/year). The SCI and thus the RH are strongly dependent on age. Using the CCS criterion for RH, 5 × 10-⁵ divers/year, and considering an average of 25 dives per year per diver, the calculated maximum acceptable SCI is 2%/year, consistent with current practice for dive medical examinations. If the SCI were to exceed 2%/year, a diver could be considered "unfit to dive," which could particularly benefit older (≥ 50 years) divers, in whom cardiovascular risk factors are often not properly treated. For the prevention of fatal diving accidents due to atherosclerotic cardiovascular disease, a dive medical examination is of limited value for young (≺ 50 years) divers who have no cardiovascular risk factors. Introducing a cardiovascular risk management system for divers may achieve a reduction in fatal diving accidents that result from cardiovascular disease in older divers engaged in both recreational and professional diving.
KW - cardiovascular diseases
KW - diving
KW - fitness to dive
KW - preventive cardiology
KW - risk assessment
UR - http://www.scopus.com/inward/record.url?scp=85137124773&partnerID=8YFLogxK
U2 - https://doi.org/10.22462/05.06.2022.9
DO - https://doi.org/10.22462/05.06.2022.9
M3 - Article
C2 - 36001568
SN - 1066-2936
VL - 49
SP - 355
EP - 365
JO - Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc
JF - Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc
IS - 3
ER -