Updated Canadian guidelines on cardiovascular fitness to drive

The Canadian Cardiovascular Society has released new guidelines on cardiovascular fitness to drive, updating those last published in 2003–2004. Cardiovascular conditions are one of the most frequent causes of impairment to drive, because they can induce unpredictable mental state alterations through a variety of mechanisms, such as myocardial ischemia, cardiac arrhythmias and vascular dysfunction. Legislation in seven of 10 Canadian provinces and all three territories requires that physicians report to regulatory authorities if a patient might pose a driving risk because of their medical condition; the remaining jurisdictions have discretionary reporting systems. The updated guidelines are designed to provide specialists, primary care providers and allied health professionals with a list of a wide range of cardiac conditions, along with recommendations about ability to drive and the suggested duration of driving restrictions. More restrictive recommendations are made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles and might transport a larger number of passengers. The guideline document is divided into seven sections:Coronary artery disease: acute coronary syndrome, post myocardial infarction, stable angina and coronary artery bypass graft (CABG) surgery (summary Table 1)Valvular heart disease (summary Table 2)Heart failure, transplantation and left ventricular assist devices (summary Table 3)Inherited arrhythmia syndromes and cardiomyopathies (summary Table 4)Rhythm and devices: cardiac implantable electronic devices, bradyarrhythmias and tachyarrhythmias (summary Tables 5–8)Syncope (summary Table 9; plus Table 10, which estimates motor vehicle accidents in the general population and in syncope cohorts)Congenital and cyanotic heart disease (summary Table 11).For each of the above sections, available data/evidence are discussed, along with tables summarizing fitness to drive recommendations for private drivers and commercial drivers for the various cardiovascular conditions within each category. For example, in chronic coronary artery disease, there are no restrictions on driving for private or commercial drivers who have stable angina or asymptomatic coronary artery disease. However, following CABG surgery, driving should be avoided for a period of time; private drivers may resume driving after one month and commercial drivers after three months. In another common condition, heart failure, there are no driving restrictions for private drivers with NYHA class I, II or III heart failure, but private drivers with NYHA class IV heart failure are disqualified from driving. Commercial drivers, on the other hand, are disqualified from driving if they have NYHA class I or II heart failure and an ejection fraction < 30%, or NYHA class III or IV heart failure. At the end of each of the seven sections, the authors provide a few practical tips to highlight key points. The guidelines include a graphic illustration (Figure 1) that summarizes cardiac fitness to drive for seven common cardiovascular conditions (e.g., infarct, bypass surgery, heart failure).The guideline authors caution that since there are no prospective, randomized trials on fitness to drive and risk of sudden incapacitation, the recommendations are based mostly on observational data from studies on various cardiac conditions, making the level of evidence moderate. In addition, when evidence was not available, consensus-based recommendations were made on the basis of best practices, historical practice and deference to safety.The guideline authors stress that these guidelines are not a substitute for physicians’ clinical judgement and their assessment of risk in clinical settings. Appropriate regard must be given to individual circumstances, patient values and preferences, and available diagnostic and treatment options. The authors acknowledge that adherence to the recommendations in these updated guidelines will reduce risk, but not eliminate it.Reference:Guerra PG, Simpson CS, Van Spall HGC, et al. Canadian Cardiovascular Society 2023 guidelines on the fitness to drive. Can J Cardiol 2024;40(4):500-23. (accessed April 25, 2024).

Updated Canadian guidelines on cardiovascular fitness to drive

Register for free access or login.

Related Topics