[pete2052]

Is there any method of appeal, (for some common sense on this change)?
I looked at the CAA complaints procedure, which seemed to involve complaint about Airlines....but nothing about themselves ..

[tr7v8]

They (CAA) will be happy once everyone gives up.

What a ridiculous thing to say.

They may make bad decisions, as all organisations do from time to time, and they may still have individuals within who have pet campaigns going on, but do you really believe that their overall strategy for GA is to eliminate it?

Having dealt with this shower when I was diagnosed with my LBBB (which is documented here, and people assisted me here) I'll stick with my version thanks. The incompetence was breath taking. My AME was struggling as well.

[BoeingBoy]

As far as I can see this provision is for those who fall into the category of 'Pilots with complications of hypertension or multiple risk factors'. Not necessarily those whose condition has been assessed and known about for some time.

I've just renewed my Class 2 at age 70 having been on Calcium Channel blockers since 2003 and also had an assessment for an LAFB in 2016 which included an exercise ECG.

Nothing was said about me having to do anything differently in the future.

[pete2052]

That's interesting, I've had a few people mention similar scenario but not be deemed necessary for an Exercise ECG.
Clause 5) CAA hypertension doc seems open to interpretation, and I do not have any complications...

[BoeingBoy]

Further to my post above and a chat with my AME. The problem lies not so much in the state of the pilot's health but the simple calculation made in cardiac arrest assessment. If that's over 10% the AME has the discretion (in Class 2) of asking for an exercise ECG.

The problem is that for any aged person on the slightest amount of BP medication it's impossible to reach a score of 10% or less, hence just about everyone would be caught up in the net.

If you wish to assess your own score the Qrisk3 calculator is here:

https://qrisk.org/

[Dodo]

Further to my post above and a chat with my AME. The problem lies not so much in the state of the pilot's health but the simple calculation made in cardiac arrest assessment.

Re Q risk...this calculates the risk of developing a stroke or heart attack in the next 10 years, not the risk of cardiac arrest.

[BoeingBoy]

Agreed but the CAA specify the following:

Class1 and Class2 pilots should have their 10 year cardiovascular risk assessed at each medical (using lipid measurements where available) and where this exceeds 10% should undergo periodic exercise testing. An OML may be required.

My AME tells me that the Qrisk tool is expressly for that purpose. The tool to assess a cardiac arrest is the ECG.

[Flyin'Dutch']

Dodo is referring to the difference between a cardiac arrest (is your ticker stops ticking and if nothing is done you're dead) and a heart attack = lack of oxygen to the heart muscle commonly caused by narrowing of coronary arteries plus/minus a clot; fckng painful and damaging to the heart muscle but ticker keeps tickin, albeit with reduced capacity.

The Qrisk calculator was devised to assess risk of heart attack/stroke to make informed decision on management of risks, not assess risk of incapacitation for flight crew, moreover the 10 year risk alluded to might be relevant to Class 1 crew as that was derived at by the assumption that flight crew would to 700 hours of jockeying around per annum. Most Class 2 folks do a fraction of that.

I am not sure how this new policy has been arrived at by the CAA but there is nothing in the public domain to indicate what has led to this change in approach, nor the calculations and decision making behind it.

[BoeingBoy]

So if the Qrisk is not an adequate tool to project heart disease for the next ten years what are you saying an AME will use?

[trevs99uk]

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...??

Nick did the CAA ever respond to AOPA regarding this..

[pete2052]

I doubt they will...how can they defend the indefensible... totally illogical!

[nickwilcock]

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...??

Nick did the CAA ever respond to AOPA regarding this..

The CAA requested specific details of individual cases, but I don't know whether our advisor was able to progress this issue further.

[pete2052]

Please can you find out? This is a big issue for many!
As an AOPA member I have already raised this issue with you but had no feedback

[Flyin'Dutch']

The CAA requested specific details of individual cases, but I don't know whether our advisor was able to progress this issue further.

Nick, that is a bit of a cop out.

They have it as a policy now for everyone and it is on that policy that we need them to take a position, and motivate that based on evidence both from medical studies as well as on cases which they have used to change their policy

Or is this just something someone thought out on a rainy wednesday afternoon?

[BoeingBoy]

This from the latest AOPA UK newsletter;

_________________________________________

Pilot Medicals

Some members have reported that their AME has told them that, when renewing a Class 2, that they now need to have an exercising ECG if over 60 and taking BP medication, even though they have been on approved medication with a stable BP for some time.

I therefore asked the CAA General Aviation Unit to explain the background of these changes and where the medical department consulted on the changes. Dr Ewan Hutchison, Lead Consultant for Medical Certification (CAA Medical Department) replied:

"There have been no significant changes in our guidance to AMEs for hypertension.
I wonder whether a few of your members have reached a point where their risk of a major adverse cardiac event e.g. a heart attack has become significant. Our hypertension guidance back to 2013 has required that those with a 10-year cardiovascular risk >10% should have further screening to determine whether or not they currently have significant coronary artery disease. What may have changed in clinical practice is the method of assessing this. With improvements in technology, cardiologists are more likely to want to undertake CT coronary angiograms than exercise testing. Our guidance still refers to “periodic exercise testing”. We are in the process of reviewing and updating our guidance to reflect the use of new technologies but have not yet shared this material with AMEs."

Statistically, using a Cardiovascular Risk Assessment tool such as this anyone over 60 is unlikely to have a cardiovascular risk of less than 10% and such an assessment could lead to a requirement to undertake further expensive screening which may not make any difference to the risk. The most likely outcome is that Pilots will not renew their Class 2 medical and either use a LAPL medical or make a PMD.

If you are a Pilot member who has recently been required to take further screening as above please let me know, in confidence, what you have been required to do, if there was any change oin your medical condition and, if you undertook screening, what were the results.

If you are an AME, could I ask you to let me know, in confidence, what your views are on the reply from Dr Ewan Hutchinson and what impact this is likely to have on Pilots over 60.