I remember there were talks about merging the patches and making it an option when building. I don't know the current status of that.
On real time operating systems, like freertos, not only the kernel is real time but everything else is too. Like: you can guarantee your call on the I2C and SPI won't take more than 5ms, for example, even with hardware issues. The whole environment is built around the hardware realtime concept.
It was late yesterday and I didn't realize I made it sound scary! Yes to all you said! The heatsink is a great idea, too.