Canadian Cardiovascular Society Issues Updated Guidelines to Assess Private and Commercial Drivers’ Fitness to Drive

The Canadian Cardiovascular Society opens in new tab/window (CCS) Fitness to Drive Guidelines opens in new tab/window have been updated to provide the latest advice on driving restrictions for private and commercial drivers. Using the CCS Risk of Harm formula and available evidence, the Guidelines document the likelihood of sudden cardiac incapacitation and highlight acceptable risk thresholds, providing guidance on when it is and is not safe to allow individuals to resume driving.

Fitness to Drive Guidelines recommendations are aimed at supporting physicians and healthcare providers to advise people with heart conditions about risks and durations for driving restrictions. Updated by a panel of national experts, these new evidence-based guidelines appear in the Canadian Journal of Cardiology opens in new tab/window, published by Elsevier.

Lead co-chair of the updated Guidelines, Peter G. Guerra, MD, Montréal Heart Institute, University of Montréal, says, "Cardiovascular conditions are among the most frequent causes of impairment to drive, because they might impair circulation of blood to the brain causing mental state alterations via diverse mechanisms like myocardial infarction, cardiac arrhythmias, and heart failure. Accordingly, healthcare providers are often asked to assess fitness to drive in patients with cardiac conditions."

The Fitness to Drive Guidelines build on and update the previous Guidelines that have been trusted and relied upon for two decades. The Guidelines take into account new data on therapies, interventions, and disease entities. These include:

• Percutaneous therapies for valvular disease

• Genetic disorders

• Recent studies looking at the risk of shock or incapacitation in patients with implantable defibrillators

Co-chair Christopher S. Simpson, MD, Queens University, Kingston Health Sciences Centre, explains, "Because there are no randomized trials on Fitness to Drive, observational studies were used to estimate the risk of driving impairment in each situation, and recommendations made on the basis of the CCS Risk of Harm formula, which remains the major, validated assessment tool. More restrictive recommendations were made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles, and might transport a larger number of passengers."

The Fitness to Drive Guidelines provide recommendations for people with these seven conditions:

• Active coronary artery disease

• Valvular heart disease

• Heart failure, heart transplant, and left ventricular assist devices

• Arrhythmia syndromes

• Implantable devices (pacemakers and defibrillators)

• Syncope (fainting spells)

• Congenital heart disease

The co-chairs suggest appropriate waiting times after cardiac interventions or acute illnesses before driving resumption. Short-term driving restriction recommendations were derived, in many instances, based on the risk of harm formula as the evidence used demonstrated diminishing levels of risk over time.

Co-chair Harriette G.C. Van Spall, MD, MPH, McMaster University, Hamilton Health Sciences Centre, and Baim Institute for Clinical Research, Boston, notes, "This document, although not a substitute for clinical judgement or governmental regulations, provides clinicians with a comprehensive list of cardiac conditions and their associated risk of sudden incapacitation. The recommendations can stimulate discussion with patients and inform decision-making regarding private or commercial driving. In some jurisdictions, they will serve as a trigger for clinicians to notify transportation authorities. Adherence to these recommendations can reduce risk to self and others whilst behind the wheel but will not eliminate it."

Dr. Guerra concludes, "If a doctor thinks a driver is a risk, in some Canadian provinces reporting to transportation authorities is mandatory. These are one of the only Guidelines issued for the safety of patients and also for the safety for those around them."

Notes for editors

The article is “Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive,” by co-chairs Peter G. Guerra, MD, Christopher S. Simpson, MD, Harriette G.C. Van Spall, MD MPH, Writing Panel: Anita W. Asgar, MD, MSc, Phyllis Billia, PhD, MD, Julia Cadrin-Tourigny, MD, Santabhanu Chakrabarti, MBBS, MD, Christopher C. Cheung, MD, MPH, Annie Dore, MD, Christopher B. Fordyce, MD, MHS, MSc, Pishoy Gouda, MBBCh, Ansar Hassan, MD, Andrew Krahn, MD, Jessica G.Y. Luc, MD, Susanna Mak, MD, PhD, Sean McMurtry, MD, PhD, Colleen Norris, PhD, MSc, RN, Francois Philippon, MD, John Sapp, MD, Robert Sheldon, MD, PhD, Candice Silversides, MD, Christian Steinberg, MD, and David A. Wood, MD (https://doi.org/10.1016/j.cjca.2023.09.033 opens in new tab/window). It appears online in the Canadian Journal of Cardiology, volume 40, issue 4, (April 2024) published by Elsevier.

The article is freely available at https://onlinecjc.ca/article/S0828-282X(23)01755-5/fulltext opens in new tab/window.

Full text of the article is also available to credentialed journalists upon request. Contact Astrid Engelen-Visser at +31 6 14395474or [email protected] opens in new tab/window for the PDF or more information. Journalists wishing to speak to the authors should contact Stephanie Naday, Director of Communications/Directrice, Communications, Canadian Cardiovascular Society/Société cardiovasculaire du Canada, at +1 403 828 1017 or [email protected] opens in new tab/window.

About the Canadian Journal of Cardiology

The Canadian Journal of Cardiology opens in new tab/window is the official journal of the Canadian Cardiovascular Society opens in new tab/window. It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice. www.onlinecjc.ca opens in new tab/window

About the Editor-in-Chief

Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About the Canadian Cardiovascular Society (CCS)

The CCS opens in new tab/window is the national voice for cardiovascular clinicians and scientists, representing more than 2,300 cardiologists, cardiac surgeons and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. For more information about the CCS visit https://www.ccs.ca opens in new tab/window.

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