CAA’s new cardiovascular rules raise questions

The CAA’s recently announced changes to cardiovascular screening for Class 2 medicals have prompted a significant response from pilots. Judging by the emails, forum posts and social media comments we’ve seen, the changes have raised questions about everything from the evidence behind the policy to the potential cost and practical impact on private pilots.

Like many pilots, we have questions of our own.

• CAA cardiac screening could affect thousands of older pilots

To better understand the rationale behind the changes, FLYER has submitted the following questions to the CAA’s press office. We are not taking a position on the policy itself at this stage; rather, we are seeking to understand the evidence, analysis and reasoning that led to its introduction so that we can accurately explain its implications to the General Aviation community.

Questions submitted to the CAA

1. We are not aware of any recent change to ICAO medical standards in this area, nor of any significant increase in accidents attributable to cardiovascular incapacitation within UK recreational aviation. What evidence, safety data, medical research or regulatory developments prompted the introduction of this change?
2. The CAA has adopted a QRISK3 threshold of 15% as a trigger for further cardiovascular investigation. Could the CAA explain the scientific evidence and risk modelling that supports the selection of 15% as the appropriate threshold for private pilots? Was this threshold derived from aviation-specific evidence or from wider cardiovascular risk-management guidance used in the general population?
3. Aviation medical certification has historically been informed by research into pilot incapacitation risk, including the principles underpinning the “1% rule”. QRISK3 predicts the likelihood of a cardiovascular event over a ten-year period. Could the CAA explain how a 15% QRISK3 score was translated into an aviation-relevant assessment of incapacitation risk during the one- or two-year validity period of a Class 2 medical certificate?
4. Prior to introducing the policy, did the CAA estimate:
   • how many Class 2 applicants would exceed the 15% threshold;
   • how many previously undiagnosed clinically significant cardiovascular conditions would be identified; and
   • the financial impact on pilots required to undergo further investigation?

   If so, could the CAA provide those estimates?

5. The CAA’s General Aviation strategy emphasises proportionate regulation and avoiding unnecessary regulatory burden. What assessment was undertaken to determine that the expected safety benefits of this policy outweigh the costs and additional requirements imposed on private pilots?

We will publish the CAA’s response in full when we receive it and, as always, we’d be interested to hear from pilots who believe they may be affected by the changes.

With thanks to Dr Frank Voeten for his assistance in compiling the medical aspects of these questions.