[T6Harvard]

Well done @BoeingBoy for asking the key questions!

Just how many GA pilots have had a cardiac event whilst airborne in the last, say, 10 years and what as the outcome both in-cockpit and with regard to the general public?

Even if the requirement for additional tests is supposedly based on RELEVANT data, which I'd like to see, is it proportionate? I don't know what I'm talking about but......
..... are they really saying that someone aged, say, 63 with well controlled BP, needs to have a <10% risk of having cardiac event before 73?? And even sillier permutations follow?

Class 2 valid for 12 months, surely the risk is for 12 months?

[johnm]

I am slightly puzzled by all this...... At age 77 my only medication is statins for elevated cholesterol and eye drops and nasal spray for hay fever. My BP is approaching the top end of normal, and a progressive increase is apparently expected with advancing years. So once my BP exceeds normal am I in for all this gobbeldegook or what???

[pete2052]

Only if you start to take antihypertensive medication (according to my AME, he has a higher qrisk3 than me, but doesn't need the exercise ECG as not on medication)
A bizarre situation IMHO, encouraging one to avoid beneficial medication, indeed I was never diagnosed as hypertensive (140/90) but encouraged to take medication as " lower would be better"...shot myself in the foot!
This only used to apply to class 1(usually not required over 65), now it applies to class 2 also, a significant change in my view, contrary the statement from CAA medical., which is clearly an attempt to brush a radical change under the carpet.

[pembroke]

Re. CAA "Class 1/2 certification-Hypertension" ,(Version 3.0 Oct 2023). Para. 5. "Class 1 and2 should have their 10 year cardiovascular risk assessed at each medical......and where this exceeds 10% should undergo periodic exercise testing." Does this only apply to "Pilots with complications of hypertension or multiple risk factors"....,as in the first sentence? Also should any cardio test be done before the medical, in my case, December this year. I have asked my AME for clarification and guidance on this.
Context, I'm an FI/FE, age 77 on the lowest dose of Amlodipine (2.5mg). I only agreed to go down this route as the Systolic was around 140 at my last medical and my aunt had a very debilitating stroke. The diastolic and resting pulse are on the low side of good.

[pete2052]

Re "Pilots with complications..." Would have thought so , but apparently CAA are insisting it applies to all.. according to my AME
Would be interested to hear what your AME says.

[malcsmith]

Hmm I'm 57... on anti hypertensives. Because of that I got a QRISK assessment.

My problem was that I once smoked a few cigars 20+ years ago. I've never smoked cigarettes, nor anything else. So that apparently classes me as an "ex-smoker" and not "non-smoker". With the rest of my figures means I get a score of 10.2. If I'm a non-smoker the score is 8.9.

I would have thought sitting in a smoky pub in 1990's probably had more of an effect on my health.

Bit peeved that I'm now caught on a Class 2 re-val which is going to cost me £700+ more.

As a part time instructor makes me think of giving up if this is annually as a test, really makes it not worth it.

btw I also run marathons, ran just over 4hrs this year, so it's not like my heart is not a problem.....

If the CAA want an example of ridiculous. I'll be running a half marathon the week before my stress ECG...

[malcsmith]

I have had contact with a couple of active UK AMEs and indeed they understand that the UK CAA wants their guidance to be interpreted like that.

There are a couple of issues with this, not in the least that the Qrisk calculator used is only valid for those with proven Ischaemic Heart Disease and those who have had a (mini) stroke and thus skewed away from the normal population who just have hypertension.

I am not sure who is responsible for suggesting this change in approach and why it was done. The UK CAA used to be renowed for its evidence based approach to risk assessments.

Maybe AOPA can make contact?

The AOPA medical adviser wrote to the CAA CMO as soon as we'd heard of this issue. But so far there's been no response..... So we've asked again for clarification. But will we get a reply this time...??

Is this a case where we should ask for an FOI? Is there an evidence based approach that demonstrates that without testing there is a material risk?

[Flyin'Dutch']

Is there an evidence based approach that demonstrates that without testing there is a material risk?

No.

Gliding has done without any testing for 60 years - No evidence that Coronary Events play a role in fatalities/accidents.

Since 2012 we have the LAPL across EASA and UK CAA land without evidence of the same and ditto PMD in the UK since 2016.

[nallen]

Out of interest, is there a corresponding QRISK criterion triggering these tests for a Class 1 medical?

[pete2052]

They have now made it the same with their latest version of:
https://www.caa.co.uk/media/4leldjqa/20 ... m-v3-0.pdf
Clause 5)…used to be just class 1

I can not see how the claim of “no significant change” holds water.

However, I hear that some AME’s are interpreting that as applying only to those with complications, which is how it reads…otherwise it should be a separate clause?

[flybymike]

Is there an evidence based approach that demonstrates that without testing there is a material risk?

No.

Gliding has done without any testing for 60 years - No evidence that Coronary Events play a role in fatalities/accidents.

Since 2012 we have the LAPL across EASA and UK CAA land without evidence of the same and ditto PMD in the UK since 2016.

NPPL declaration goes back to around 2002?

[Flyin'Dutch']

Out of interest, is there a corresponding QRISK criterion triggering these tests for a Class 1 medical?

The Qrisk score is used for a number of issues and by teh CAA it was used in the past to see if diabetic patients needed a cardiac workup as part of their assessment to be fit to be issued with a medical.

But it hasn't been used for the assessment of other illnesses.

And for Class 1 a cardiac assessment is required for pilots over the age of 64 irrespective of other illnesses etc, but that was not predicated on Qrisk but on the risk of cardiovascular disease as a result of getting older (as that is the biggest risk factor for it)

[Irv Lee]

I checked through, don't think I missed them, but no-one seemed to comment on a post by @TomWW who (paraphrasing) was, if I understood correctly, pointing out that class two pilots do not fly 24 hours a day, 365 days per year so surely risk of the defined problem in the next 10 years is completely different to the risk of it happening whilst an individual is flying which surely should be the goal behind the risk calculation here... shouldn't it? Or what don't I get?

[pete2052]

Yes, of course it should….but we are up against the CAA who have made a non evidence based unilateral decision, no consultation and not listened to their AME’s.

[Kemble Pitts]

Is AOPA making any representations about this? This has the makings of a very significant issue for GA.