Fact Check: The FAA has broadened their ECG requirements to include people with heart trouble.

Jan 22, 2023

Steve Kirsch reported that the FAA has broadened their ECG test requirements

Steve Kirsch first reported this story; it was pilot Josh Yoder at US Freedom Flyers who alerted him to the story; consider making them a donation.

The FAA has broadened their ECG testing requirements quite considerably, to include people with heart trouble. This story is actually true.

They have rather craftily reordered their whole website somewhat to hide the change, and for some reason on https://web.archive.org, the original PDF of all the pilot medical requirements is no longer available.

However, the webpage version was still available on web.archive.org and here is what I found.

Acceptable PR Interval, old and new, on the FAA Normal Variants Page

The acceptable PR interval for first-degree AV block was widened from 0.21 (210 ms) to 0.3 (300 ms).

This archive.org address is the old ECG Normal Variants page:

https://web.archive.org/web/20220309003311/http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/Normal_Variants.pdf
Here is a screen shot:

Here is the new Normal ECG Variants page, revised on October the 26th 2022:

https://web.archive.org/web/20221031131522/http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/Normal_Variants.pdf

Here is the screen shot:

But what does it mean? A Brazilian study tells us the odds.

A large Brazilian study with a cohort of 1,557,901 patients recently found that atrioventricular block (i.e. a rhythm change in the heart) with a PR interval (interval between heart beats) of more than 200ms was associated with a 24% lower survival rate than the control group.

In a mean follow-up of 3.7 years, the mortality rate was 3.35%.

While it is a large study, there are limitations involving the mean age of the subjects, but if this result is applicable then in approximately four years, 1 out of every 30 pilots in the FAA who have been passed by the FAA Doctor and wouldn’t have been beforehand is going to die.

As I outline further on, the question is, how many pilots actually have first-degree AV with a PR interval of over 200ms?

Another recent study clarifies the risk - if PR >270 it’s an increased risk of death.

Another recent study published in Heart Rhythm O2 (Yarmohammadi et al Dec 2022) found that any PR > 270 ms is significantly associated with higher incidence of Atrial Fibrillation, HFH (Heart Failure Hospitalisation, which sounds like it’s fairly incapacitating to me) and death, at a greater than .05 P level. This study is quite important because it uses long-term device diagnostic data - in other words, data from pacemakers and defibrillators. It’s hard to argue with this level of medical data collection - these devices are measuring everything, 24 hours a day.

Results
A total of 25,752 patients (age 69.3 ± 13.9 years; 58% male) were evaluated. The average intrinsic PR interval was 185 ± 55 ms. In the subset of 16,730 patients with available long-term device diagnostic data, a total of 2555 (15.3%) individuals developed AF during 2.59 ± 2.18 years of follow-up. The incidence of AF was significantly higher (up to 30%) in patients with a longer PR interval (ie, PR interval ≥270 ms; P < .05). Time-to-event survival analysis and multivariable analysis showed that PR interval ≥190 ms was significantly associated with higher incidence of AF, HFH, or HFH or death when compared with shorter PR intervals (P < .05 for all 3 parameters).
Conclusion
In a large real-world population of patients with implanted devices, PR interval prolongation was significantly associated with increased incidence of AF, HFH, or death.

Addendum

I’ve put the Addenda here, in the middle, as the odds calculation section is rather frivolous but this new information is important.

The FAA broke their own rules about pharmaceuticals - from a commenter on Steve Kirsch’s story, who himself is a pilot, Dan Nelson:

Do Not Issue - Do Not Fly, directed at Aviation Medical Examiners (AME's): "For any medication, the AME should ascertain for what condition the medication is being used, how long, frequency, and any side effects of the medication. The safety impact of the underlying condition should also be considered...FDA (Food and Drug Administration) approved less than 12 months ago. The FAA generally requires at least one-year of post-marketing experience with a new drug before consideration for aeromedical certification purposes. This observation period allows time for uncommon, but aeromedically significant, adverse effects to manifest themselves..."

https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/pharm/dni_dnf/

Dan Nelson continued:

Any Doctor who read the prescribing guidelines (most didn't and don't) for these "vaccines" when they were released would've recommended against taking them, especially to their pilot patients.

Myself, I think it’s doubtful that every Doctor who knew the guidelines would have recommended against the vaccines: I think they all knew what they were expected to say, and very many of them were probably too afraid of losing their medical licenses to buck the system.

Addendum 2 - Reuters and others fail the fact check test.

Reuters fails the unbiased fact check test by already assuming the outcome in their email to Steve Kirsch. Clearly they didn’t even do the work I did to verify the claim, which is perfectly verifiable on the faa.gov website.

But Reuters is not as bad as Associated Press, where they allow the cardiologist to make scientific assertions without citing any studies, data or evidence:

“In an otherwise healthy heart, this is usually a benign condition and rarely causes any symptoms,” said Dr. Roland Assi, a cardiac surgeon and assistant professor at Yale University. “In general, it does not require specific treatment besides a complete evaluation by a physician.”
Dr. Eric Adler, a cardiologist and professor of medicine at the University of California, San Diego, said it is not uncommon for people to have such delays.
“If the block is less than 300 milliseconds there is no indication for further therapy nor increased risk or impairment of bodily function,” he explained.

And this paragraph directly contradicts everything Associated Press claims - the pilots don’t even have to justify their cardiac safety with extra documentation:

Previously, pilots with first-degree AV block were required to submit documentation proving that they had “no evidence of structural function or coronary heart disease” before they could be certified to fly. The FAA’s recent update to its guidelines specifies that pilots with first-degree AV block and a PR interval of less than 300 milliseconds can be certified without additional documentation if they are not exhibiting symptoms and if their medical examiner does not have any concerns

What evidence does Dr Adler have for his assertion that it will not impair bodily function? The two recent studies I found in my search on google scholar directly contradict what he says.

And don’t forget Yahoos who say the FAA cardiologists claim that there is new scientific evidence but do not ask them what it is.

The change was made after cardiology consultants provided new scientific evidence showing that anything under 300 milliseconds is not a risk for sudden or subtle incapacitation, the FAA spokesperson said.
The new standard is still stricter than standards in other industries. For example, in healthy athletes a PR interval less than 400 milliseconds is considered normal, Dr. Richard Kovacs, chief medical officer at the American College of Cardiology, told USA TODAY in an email.
There’s also no evidence of a large number of pilots suffering heart damage from the COVID-19 vaccine as the post claims, Kramer added.
The FAA spokesperson said that there is "no evidence of aircraft accidents or incapacitations caused by pilots suffering medical complications associated with COVID-19 vaccines." Multiple airlines have told USA TODAY the same.

Well there wouldn’t be evidence of a large number of pilots suffering heart damage yet, would there, unless you were specifically looking for it? No, the evidence will come in the next five years as the mortality stats work themselves out.

And Politifact, where they swallow the FAA administration’s explanation quite happily:

The administration has "no evidence of aircraft accidents or incapacitations caused by pilots suffering medical complications associated with COVID-19 vaccines," a statement from the agency said. "When making changes to medical requirements and guidance, the FAA follows standard processes based on data and science. New scientific evidence enabled the FAA to safely raise the tolerance used to screen for a certain heart condition."

What scientific evidence?

What data?

You asked them to cite the studies did you?

I cannot find any studies that say that a PR of more than 200 ms and less than 300 ms is associated with less risk. The two very recent studies I can find, large cohort studies, say it is associated with more risk. The only exception noted in the Brazilian study, that is, a heart block not associated with increased mortality, is Mobitz type 1 heart block - but this is a specific type of heart block in which the PR interval is not consistently broadened. (The other question I have is, where is this result on the graph in the Brazilian study? All the fields are lower than the control. )

Associated Press, Politifact, Yahoo wins their places in the first fact check hall of infamy.

And USA today, who seems to have been the first to fact check this, apparently reached out to the social media users who shared the claim for comment. They swallowed the FAA statement, hook line and sinker:

The FAA spokesperson said that there is "no evidence of aircraft accidents or incapacitations caused by pilots suffering medical complications associated with COVID-19 vaccines."

Well there wouldn’t be, would there?

Yet.

Links to Covid Vaccines.

Well I think we all know people who have died suddenly following receipt of the safe and effective vaccines. Associated Press, Politifact, Yahoos, and USA today all downplay any links, but the fact is, without proper data and studies exploring the links, with heart effects examined scientifically (not just hospital effects), they’re all just relying on the argument from authority, an invalid argument (Nullius in verba). But the question of why the FAA would suddenly broaden their medical safety requirements for patients remains. What is the new evidence that <300ms is safe? There isn’t any.

But what are the odds?

It’s always a bad idea to calculate the odds.

After all, we all risk death by many means every single day, and anyway, if you are a Christian, you don’t have to worry about the odds, because God will keep you alive so long as you have a purpose in this life for His kingdom. And for all of us, when it’s our time to die, it’s our time to die. God knows when that will be; it’s in His plan, and we should every day wake up and turn back to Him and make sure we’re ready to go; may the Lord give us grace to do so, because none of us knows when his number is going to be up.

Don’t read this if you are flying soon!

But here are the odds, anyway, read them at your own psychological risk; don’t read this, though, especially if you are flying soon! (Oh dear, oh dear. I know human nature, the one who is flying soon will be the very one who has an irresistible urge to read it, I just know it. Don’t read it!)

(You know you will, you won’t be able to help it!)

I mean it don’t read it!

Arrgh! Okay here it is anyway. Maybe my adding up is wrong anyhow, comfort yourself with that. It probably is. I’ve probably overestimated the risk, tell yourself that.

Addendum - initially I did overestimate the risk - corrections follow.

The fact is that every single pilot will not have the full increased risk. The Thai study, which examined every single student at a school (instead of taking hospital attendance statistics which most do), found that 30% of the Covid-10 vaccinated students had heart damage. I’ll assume 1 in 10 Covid-19 vaccinated pilots have heart damage of the type that leads to a change in the PR interval.

Anyway here goes: the maximum number of hours any pilot may fly in the US is 1000 hours per year.

If your pilot actually happens to be one of the ones with this medical condition: there are about 8766 hours in a year, 32434 hours in 3.7 years. That means your chances of your particular pilot dying while you’re in a particular flight is 1 in 33,330 for each hour of your flight. For an eight hour flight that is really relatively large odds: 1 in 4,162. Compare it to the odds of a (say) 40 year old male dying in any particular eight hour period, which is about 1 in 456,000.

Yup, but if you are flying with a pilot who has been passed by the FAA’s new medical rules, and wouldn’t have been beforehand, your odds of being in a plane where one of the pilots dies are increased by 100 times. Maybe ask your pilot, “Did you have a PR of over 200 ms in your ECG?” If a look of shocked recognition comes into his eyes and he says, “I’d rather not answer that question,” don’t get on the flight!

Of course, if one of every ten pilots have this condition, for an eight hour flight your odds have increased 10 times. If it’s one of every three pilots, it’s 30 times, but we just don’t know how many pilots have this condition.

International travel or travel in a jet of some sort is probably safer though as there are usually two pilots.

This might explain the rumour that the WEF attendees were looking for unvaccinated pilots, for while most jet flights apparently involve two pilots, some private jets are certified for a single pilot, perhaps the smaller planes; But still…

What are the odds two pilots are going to die at the same time?

The chances that this is actually going to happen with two pilots dying in the same flight some time in the next 3.7 years is relatively high, too, taking into account the number of flights in the US, and globally.

Correction - initially I said I don’t know the risk between 200ms and 300ms - now I have found a large study that tells us the risk is greater for death PR >270ms. Perhaps I have overestimated the chances of having a long PR measure anyway for vaccinated pilots; it is probably less than 1 in 10. But it could be as high as 1 in 3.

But here is my best guess anyway:

A conservative estimate of the number of flights this year globally is 16.4 million; the number of flights in the US in any one day is over 45,000 according the FAA. This means the number of flights will be somewhere around 61,000,000 flights in the next 3.7 years, both in the US and globally (of course there’s something wrong with that figure; I think the FAA is probably closer). But if my statistics are correct, then the chances that both pilots will die in an eight hour flight is 1 in 173,264,060. Considering that the number of flights in the next 3.7 years is 61,000,000; well, we can expect around 0.4 planes to go down in the next 3.7 years because of pilots dying, because of heart issues.

That’s about one extra plane crash in the next ten years, caused by both pilots dying of a heart attack at the same time.

The one thing you really don’t want.

As I said, it depends really on how many pilots actually have this type of heart damage. If it’s 1 in 3, it’s one extra plane crash in the next 3 or 4 years, which is unacceptable. If it’s 1 in 50, it means one extra plane crash in the next fifty years, which seems less worrying. But is still bad.

If every pilot has heart damage of this sort, it is slightly more than one extra plane crash per year, for the next 4 years.

A worrying thought I just had - the fact is, that there must be a lot of pilots who have first degree AV with PR of over 200 ms, otherwise, why did the FAA change the rules? The only possible reason they would have had for changing the rules is that they were worried about not having enough pilots.

Perhaps they’re already low on pilots, because of not allowing the unvaccinated ones to fly?

I have to admit I don’t know the figures of how many pilots have heart damage, but, the fact is, it’s probably time to graciously and humbly ask those unvaccinated pilots back…. don’t you think? Ever heard of the precautionary principle, FAA?

What the FAA should do really, is order ECGs of all their vaccinated pilots now; at least then they would know the increased risk.

The best solution? Pray!

And here’s my spiritual advice:

Pray for the whole aviation system, actually, that these pilots don’t die while they’re flying a plane.

Pray that I’m wrong! That my less conservative estimates here are wrong, that my more dire predictions don’t come true.

Pray that the FAA actually reverses this rather stupid decision.

And turn to God

And turn to God now, if you haven’t lately.

No one knows when their number will be up.

Trusting and believing in Jesus is the only way to know your eternal destiny, by faith.

Because Jesus promises not to turn anyone away who comes to Him, and He died on the cross for the sins of the whole world.

I pray God the Father will draw to Himself everyone who are reads this. (see John 6:37)

First Fact Check Hall of Infamy

Change log

I did a lot of tweaking in the statistics estimate section after I sent this one out. The great area of uncertainty is, how many pilots have this type of heart damage?

On 26th Jan added the extra study and the fact checkers.