All pilots in the USA must undergo medical certification by an aeromedical examiner (AME) at regular intervals. The Federal Aviation Administration (FAA) administers AME seminars to certify physicians as AMEs. One of the most well-received lectures during this seminar is a multispecialty panel entitled ‘would you fly with this pilot’. As an AME and federal air surgeon (FAA) cardiology consultant, I teach many of these courses and also review many cases of pilots with heart disease for the FAA as well as all five branches of the US military. My wife often jokes that if I recognize a pilot in an airport, she “would not fly with that pilot;” however, I assure her that if I have evaluated that pilot, then they are safe to fly. But what about the pilot I have not seen? Surely all pilots are screened for heart disease?
I read the article ‘Cardiac Screening and Long-term Outcomes in Aircraft Pilots’, recently published in Heart, with great interest.1 Cardiovascular disease (CVD) remains the leading cause of mortality in developed countries worldwide and a leading cause of aeromedical disqualification in aircrew. Acute coronary syndrome has also been linked to numerous commercial aircraft incidents.2 Therefore, the pilot’s cardiovascular health is crucial, not only for their safety but for the safety of their passengers and those on the ground below. In the case of military pilots, mission completion is also essential. If the mission fails, not only may people in the aircraft perish, but so may the soldiers, marines or airmen they were going to rescue. …
