Is it OK for me to travel? What to tell patients living with heart failure

Introduction

Heart failure (HF) is a clinical syndrome caused by structural or functional impairment of the heart that results in symptoms such as shortness of breath, fatigue, reduced exercise tolerance and fluid retention (Brake and Jones, 2017). An estimated one million people in the UK have heart failure (British Heart Foundation (BHF), 2025).

Although HF is associated with significant mortality and morbidity, outcomes in this patient group can be improved with access to specialist care, disease-modifying, guideline-directed medical therapy and adherence to self-management strategies (McDonagh et al, 2021; National Institute for Health and Care Excellence (NICE), 2018). As a result, those living with this diagnosis must navigate a complex medication regime involving several different drugs, while managing their fluid balance and carefully monitoring their symptoms. While this can be difficult in the context of day-to-day life, travelling – whether it be for the purpose of taking a holiday or for another reason – presents additional challenges and considerations, and it is common for nurses to be asked for advice. Guided by the Nursing and Midwifery Council (NMC) Code (2018), it is essential that nurses caring for this group of patients are able to give individualised, factual and practical advice that is within their scope of practice.

Can people living with a HF diagnosis travel?

In most instances, the answer is yes, they can. People with a HF diagnosis live the same lives as everyone else. They plan holidays, family get-togethers and take business trips. With forward planning and organisation, travel can be both safe and enjoyable (heartfailurematters, no date a). However, unplanned trips may make preparation more of a challenge for people living with HF. Whatever the reason for travel, several issues must be considered, including choice of destination, getting to and from the destination, travel insurance, medication and device management, self-management strategies and what to do in an emergency.

Destination

First and foremost, when planning a trip, it is important to consider the choice of destination, taking into account elements such as temperature, altitude, and the potential impact of jet lag. Extreme temperatures, whether hot or cold, can adversely impact how the body functions, and potentially affect the stability of HF, so caution is advised when considering such countries.

Heat stress through high temperatures and high humidity can lead to worsening of HF symptoms and heat stroke due to the cardiovascular system’s inability to regulate the internal body temperature (Liu et al, 2022). Changes in fluid and electrolyte balance may increase the risk of arrhythmia, and for those taking diuretics, increase the likelihood of dehydration if fluid loss exceeds fluid input (Alahmad et al, 2022).

In colder climates, wearing layers helps to trap heat and keep body temperature stable, reducing strain on the heart (BHF, 2024). Cold weather can also make it easy to overlook possible sources of exertion; simply walking in the snow can cause potentially dangerous levels of exertion (BHF, 2024). It is, therefore, advisable for people with HF to travel in the spring or autumn of the destination country, thereby reducing exposure to extremes in weather conditions (von Haehling et al, 2022).

Altitude should also be considered when choosing a holiday destination. High altitude is often thought to increase the burden of HF symptoms because lower oxygen in the air at altitude forces the heart to work harder (Mallet et al, 2021). Individuals with a history of cardiac arrhythmias or pulmonary hypertension should avoid exposure to altitudes above 2,500m. For those with coronary artery disease and HF, the advice should depend on the functional state of the patient (Mallet et al, 2021).

Getting to and from the destination

Once the destination has been decided, some thought needs to be put into the mode of transport. Many people will choose to holiday abroad and travel by air. While air travel is safe for most people living with HF, those who experience shortness of breath at rest are cautioned not to travel by aeroplane, and if air travel is unavoidable, onboard oxygen should be considered in advance (von Haehling et al, 2022). For others, a driving holiday may be more appealing. Anyone considering this option should check whether they are allowed to drive by consulting specific driving regulations of the destination country online.

Regardless of the mode of transport, the risk of deep vein thrombosis (DVT) is greater in people living with HF. Strategies to prevent the development of DVT include wearing loose, comfortable clothing, taking frequent walks, performing calf muscle exercises, using elastic compression stockings and maintaining adequate hydration (von Haehling et al, 2022).

Travelling can be stressful, and this stress can negatively affect someone’s wellbeing when on holiday. Women are generally more likely than men to seek pre-travel medical advice; however, they are also more likely to experience travel-related worries (von Haehling et al, 2022). Planning the trip and organising several key factors can help manage travel stress (BHF, 2024).

Travel advice includes:

• Use wheeled suitcases to help reduce physical effort;
• Plan the route through the airport, allow additional time to move through it, and arrange assistance at the airport in advance to reduce exertional stress;
• Stay in accommodation near to amenities such as shops and restaurants;
• Ensure that accommodation is suitable and easily accessible;
• Familiarise yourself with local emergency numbers and know how to get help if needed;
• Travelling by train, road or sea excludes concerns regarding airport stress, however, navigating unfamiliar roads and public transport in a foreign country can also be challenging, so forward planning is advised where possible (von Haehling et al, 2022).

Travel insurance

When travelling, it is recommended that patients with HF take out health insurance. It is important to disclose all medical conditions and understand what the policy covers in terms of treatment and care (BHF, no date). Those travelling with a European passport within the European Union can use a European Health Insurance Card (EHIC) to access free or lower-cost treatment within the European Economic Area. As a result of the UK leaving the European Union, the EHIC was replaced with the UK Global Health Insurance Card (GHIC). It allows UK citizens to access medically necessary state healthcare within the European Economic Area on the same basis as a local resident, so may require a fee (NHS, 2023). Neither the EHIC nor the GHIC should be considered a substitute for insurance (heartfailurematters, no date b; NHS, 2023). Organisations such as Pumping Marvellous and the BHF are useful sources of information on travel insurance for patients with HF.

Travelling with medication

It is important that people remember to take all their medication on holiday, ensuring they have enough for the duration of the trip, plus an additional two days in case of delays or cancellations. Carrying medication in hand luggage is advised in the event of lost checked luggage. It is also recommended to bring a list of all medications in case any are lost while abroad. The list should document both the drug’s generic name as well as the brand name, as drug details may vary in other countries (heartfailurematters, no date c).

If patients are taking a controlled drug, they must also carry it in their hand luggage and provide a valid prescription or a letter from a doctor to avoid confiscation (UK Government, no date). However, some countries do not permit certain medications, even if accompanied by a prescription or doctor’s letter (Centers for Disease Control and Prevention, 2022), while others, such as Japan, do not allow certain over-the-counter medications, such as Sudafed and Vicks inhalers, which contain pseudoephedrine (Japan Travel, 2023; Madormo, 2022). To avoid legal issues when traveling abroad with medication, it is crucial to consult the embassy or consulate of the destination country to understand their specific regulations. Additionally, carrying medications in their original packaging, along with a copy of the prescription and a doctor’s letter, can help facilitate the process (Home Office, 2023).

If the holiday involves flying through different time zones, it can be difficult to manage specific medication regimes, as the usual time for taking medications might be disrupted. The BHF recommends taking medication as prescribed on the day of travel, then 12 hours later, before getting back into a normal pattern (BHF, 2024). If in doubt, patients should consult their HF nurse, GP or pharmacist for reliable information.

Photosensitivity

Several medications used in the treatment of HF, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), loop and thiazide diuretics, have been associated with increased photosensitivity. While this list is not exhaustive, it is certainly something to consider when discussing travel plans with patients. The typical presentation of this adverse effect is a burning and tingling sensation in sun-exposed skin, with associated erythema (Von Haehling et al, 2022). Factors that affect the degree of photosensitivity include the time of day, season, geography, altitude and weather. Sunscreens with a sun protection factor (SPF) of 30 or higher are recommended (von Haehling et al, 2022)

Travelling with a cardiac device

Travelling with a cardiac device, such as a loop recorder, pacemaker or implantable cardioverter defibrillator should not pose any significant problems. However, it is advisable to carry a device identification card and alert airport staff to the presence of the device before going through an airport security scanner (BHF, 2024). Patients who have been advised that their device may be affected by the scanner can request a manual search. If in doubt, patients should contact their device clinic for advice before they travel (Pumping Marvellous, 2022).

Self-management strategies

Self-management and symptom monitoring are an important part of HF care, and those living with a HF diagnosis should be equipped with the knowledge to recognise the signs and symptoms of deterioration and know what action to take (NICE, 2018). They should also be educated on fluid management, fatigue management, and what to do in an emergency (McDonagh et al, 2021). Providing and reinforcing the importance of the information is a fundamental part of the nursing care for these patients.

Diet and fluid intake management

Management of fluid balance is a specific consideration when travelling abroad. Warmer climates and increased thirst may lead to a higher volume of fluid consumption, potentially leading to volume overload. Patients at risk of volume overload, or those who take high doses of diuretics, should be advised to check their body weight regularly (von Haehling et al, 2022) and be given advice about adjusting their diuretics if a weight gain of >2kg over two days is detected. Conversely, greater insensible fluid loss might raise the risk of dehydration. In hot and/or dry destinations, an additional intake of 0.5–1.0L per day of non-alcoholic drinks is recommended (von Haehling et al, 2022).

The risk of dehydration is made greater if there is further fluid loss from gastrointestinal upset. In this instance, pre-travel education on the importance of the ‘sick day rules’, where certain drugs are temporarily withheld until symptoms resolve, is vital (Pumping Marvellous, no date). Examples of medication to withhold under sick day rules include diuretics, ACE inhibitors, ARBs, neprilysin inhibitors, SGLT2 inhibitors, mineralocorticoid receptor antagonists, metformin, some sulfonylureas, trimethoprim, and non-steroidal anti-inflammatory drugs.

The way people consume alcohol often changes during a holiday. Increased alcohol intake is associated with increased risk of cardiac arrhythmias and hypertension. In addition, the increase in fluid volume associated with increased alcohol intake may aggravate symptoms of HF and contribute to volume overload, so patients should be advised to avoid overconsumption and adhere to recommended limits (von Haeling et al, 2022; McDonagh 2021).

During a holiday, increased consumption of foods high in salt can adversely affect the balance between sodium and fluid status, which can worsen HF symptoms due to fluid retention. Individualised pre-travel education and advice about managing salt and fluid intake is vital to prevent a deterioration in symptoms (von Haeling et al, 2022).

Emergencies

It is important for patients with HF to know what to do in an emergency while travelling. Patients should have their travel insurance documents, a list of medication, previous medical history and emergency contact details to hand, and to be aware of how and where to get medical attention at their destination (heartfailurematters, no date b; heartfailurematters, no date c).

Conclusion

For people living with HF, considering all the points raised in this article when looking to plan and take a holiday may initially seem overwhelming. Ultimately, the aim of all professionals caring for those with a HF diagnosis is to empower people to live well with their condition. For many, having a holiday is an important part of normality and can help to improve quality of life. With some consideration, preparation and planning prior to a trip, people living with HF can travel safely and enjoy their holidays.