Medical screening of recreational divers for cardiovascular disease: consensus discussion at the Divers Alert Network Fatality Workshop.

Cardiac events are responsible for a significant proportion of recreational diving fatalities. It seems inescapable that our current systems for selecting suitable recreational diver candidates and for longitudinal monitoring of diver health are failing to exclude some divers at high risk of cardiac events. Based on review of practice in parallel sporting disciplines and of the relevant literature, a series of recommendations for screening questions, identification of disqualifying conditions and risk factors, and investigation of candidates with risk factors was drafted. Recommendations for ongoing health monitoring in established divers were also generated. These recommendations were promulgated and debated among experts at a dedicated session of the Divers Alert Network Fatality Workshop. As a result, we propose a modified list of screening questions for cardiovascular disease that can be incorporated into health questionnaires administered prior to diver training. This list is confluent with the American Heart Association (AHA) preparticipation screen for athletes. The exercise stress test unmasks inducible cardiac ischemia and quantifies exercise capacity, and remains the tool of choice for evaluating diver candidates or divers with risk factors for coronary disease. An exercise capacity that allows for sustained exercise at a 6-MET intensity (possibly representing a peak capacity of 11-12 METS) is an appropriate goal for recreational divers.