2023 Canadian Cardiovascular Society Guidelines on the Fitness to Drive

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The Canadian journal of cardiology


Cardiovascular conditions are among the most frequent causes of impairment to drive, as they may induce unpredictable mental-state alterations via diverse mechanisms like myocardial ischemia, cardiac arrhythmias, and vascular dysfunction. Accordingly, health professionals are often asked to assess patients' fitness to drive (FTD). The Canadian Cardiovascular Society (CCS) previously published FTD guidelines in 2003-2004; here, we present updated FTD Guidelines. Because there are no randomized trials on FTD, observational studies were used to estimate the risk of driving-impairment in each situation, and recommendations made based on CCS Risk of Harm formula. More restrictive recommendations were made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles, and may transport larger numbers of passengers. We provide guidance for individuals with 1) active coronary-artery disease; 2) various forms of valvular heart diseases; 3) heart failure, heart-transplant and left-ventricular assist device situations; 4) arrhythmia-syndromes; 5) implantable devices; 6) syncope history; and 7) congenital heart-disease. We suggest appropriate waiting-times after cardiac interventions or acute illnesses before driving-resumption. Where short term driving-cessation is recommended, recommendations are based on expert consensus rather than the Risk of Harm formula since risk-elevation is expected to be transient. These recommendations, while not a substitute for clinical judgment or governmental regulations, provide specialists, primary care providers and allied health professionals with a comprehensive listing of a wide range of cardiac conditions, with guidance based on the level of risk of impairment, along with recommendations about ability to drive and the suggested duration of restrictions.

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