Seafarers have a lot of job-related risk factors for CVD. Taking into consideration the healthy-worker effect due to the pre-employment examination and the periodical medical fitness tests seafarers seem to be at (slightly) elevated risk for cardio-vascular diseases compared to the reference population ashore. The prognosis of acute severe CVD often depends on the measures taken in the first few hours after occurrence of the symptoms. Diagnosis and treatment of CVD are a considerable challenge for the medical lay-person on board and necessitate a close interaction with the medical assistant service. As the medical advice usually relies on the information given by non-medical health officers these persons have to be well-trained. Thus, medical refresher courses at a high standard should train the first-aid skills and can consequently improve the outcome, in severe cases the survival, of patients with CVD at sea. It can be assumed that additional diagnostic parameters such as Tropinin-quick test or ECG (recorded by a semi-automatic defibrillator and interpreted by a radio medical centre) will further improve efficiency of treatment of patients with acute cardiovascular diseases.
As prognosis of CVD is worse at sea compared to that on-shore the question about the medical fitness-decision raised especially in seamen who obviously have increased CVD risks or already have suffered from heart diseases. This topic is discussed elsewhere in the textbook. More effort should be paid to raise the seafarer’s awareness about their individual risk for CVD and to advice them on prevention. It should be a joint attempt of the shipping company (e.g. by a satisfactory offer of shipboard exercise possibilities, a more balanced diet or of health information campaigns), the ship masters (e.g. by active motivation of his crew to use these offers) and the seafarers themselves (e.g. to abandon poor health and eating habits and to be more responsible for their health promotion).