Disparity between estimates and measures of maximum heart rate in pilots with coronary artery disease

Background : Several studies indicate that HRmax estimates using the traditional equation, HRmax = 220 - Age, may represent a regression slope and intercept that does reflect the true relationship between age and maximal cardiac frequency. Meta-analysis of several pertinent studies indicates that 220-Age significantly under-estimates the true HRmax, particularly in older patients. This is a critical issue in the exercise evaluation of pilots with CAD who seek reinstatement of an aviation medical certificate after a cardiac illness because end-points in exercise testing and fitness assessment are based upon the 220--Age method of HRmax estimation.