How soon are heart patients safely fit to drive?

9 Jul
by Carolyn Thomas      @HeartSisters

Almost all freshly-diagnosed heart patients are warned not to drive for a specific period of time following hospital discharge, ranging anywhere from 24 hours to several months, depending on the specific cardiac issue.  And in the earliest days or weeks, we may have mixed emotions even thinking about getting behind the wheel of a car again.

Some of us might feel afraid to drive (“What if I have another cardiac emergency while driving by myself on the highway?”).  A Swedish study that followed drivers living with chronic illness (including cardiovascular disease) over a 10-year period found that very few road accidents were directly caused by either the disease or its treatment after early driving restriction time periods had passed (just 0·8% of all cases).  Despite those stats, the researchers reported that many individual drivers voluntarily surrendered their driving license post-diagnosis because of the personal decision that “my state of health was no longer compatible with safe driving.” (1)

Some of us, however, can’t wait to grab our own car keys, a major psychological step toward being able to feel “normal” again (a quality of life factor that’s often diminished by being suddenly dependent on others to drive us around).

So how do we know which of us are actually competent to resume driving after a cardiac diagnosis, and which of us are no longer safe on the road? 

Ironically, drivers themselves are rarely the best qualified to accurately assess our own competence to drive. We know, for example, that even the worst drivers on the road rate their own driving competence far higher than it actually is. Just try arguing with a drunk who insists he’s okay to drive home from the pub. . . Here’s an example of that: a study on drivers living with chronic pain noted “chronic pain patients rated their subjective driving quality to be ‘normal’, although their road driving testing ratings and degree of alertness were actually significantly lower.” (2)

The good news: governments that regulate road safety do assume that most people diagnosed with a heart condition (with some exceptions – see list below*) will eventually be fit to drive again, and almost all have guidelines created with the help of medical experts. Here in Canada, doctors refer to guidelines called Assessment of the Cardiac Patient for Fitness to Drive, a partnership project between the Canadian Cardiovascular Society and public road safety agencies.

I recently raised this issue with other women who are living with heart disease, and here’s a sampling of their comments:

  • I have had some scary times when symptoms suddenly came on while driving
  • I only drive in a 4-mile radius and no driving at night
  • There were a few times I had to pull over to the side or a parking lot to spray nitro and rest
  • I can and do drive, but it takes a lot out of me
  • I do not drive for longer than about 45 minutes at a time
  • I haven’t had to quit driving, but I take a lot of time considering if I’m doing too much. How medications are affecting me that day. Am I short of breath? Too tired to make good decisions? Most days I don’t drive, but I can.
  • After I drove home from work on several occasions feeling extremely unwell, my husband started taking me to work
  • Symptoms are so unpredictable that I never know when it can go from being okay one minute to being unable to stand it the next
  • I drive to work as it’s only 10 minutes away
  • I have not mentioned it to the doctors, afraid they will take away my license
  • I love my truck and my family… I wouldn’t want to ruin any one of them, or ruin somebody else’s life!

Let’s consider a commonly imposed post-op driving restriction: if you have just undergone open heart surgery, for example, it’s likely that you were told you cannot drive for 4-6 weeks now, depending on your physician’s assessment of your recovery.

I’ve heard from a number of heart patients who question this guideline, arguing that they “need” to drive, that they felt well enough to drive long before that time restriction expired, and that driving is their right. Many express frustration about arbitrarily strict rules imposed on them by road safety bureaucrats.

But consider the perspective of this patient who shared an opposing view on an online patient community for people who have undergone open heart surgery:
“Six weeks with no driving is not unreasonable!
.
“Some of the drugs you’re now taking for post-op pain even warn right on the label: “Do not drive while taking this medication”.  After your surgery, your sternum is healing. You wouldn’t pedal a bike after breaking your leg, would you? Driving a car requires you to be alert, mentally and physically. Many heart patients can have complications in the early weeks after surgery ranging from heart rhythm problems to high blood pressure, low blood pressure, balance issues, nerve damage problems, and even severe cardiac complications like heart attack. Do you want to discover you have any of these issues while operating a 3,500-pound land missile on a busy highway?
.
“To drive in the first six weeks despite being told NOT to drive by a physician places you in huge legal problems if you do have an accident. You’re putting not only you but other innocent people around you at risk – and you would be wholly responsible if you cause an accident!
.
“Lastly, consider this. Let’s say you’re a recent open heart surgery patient who lost consciousness or became disoriented while driving, slammed into my family’s car, and managed to survive. As soon as my lawyer learned that you were less than six weeks post-op, that lawyer would grind you into pulp, financially and legally! Your insurance company might not even cover you because you were not supposed to be driving. Your doctor could be called to testify that you should NOT have been at the wheel, as would any other expert witnesses.
.
“If I sound pretty harsh, it’s for a reason. We recently had a neighbour who had surgery, behind the wheel just two weeks after his procedure. He blacked out and slammed into the rear end of a car, killing two little kids and seriously injuring their parents. What kind of an idiot does this after being told by a doctor not to drive?  This is why you don’t drive in the first six weeks!”
* Recommended wait times before driving after a cardiac event may vary depending on where you live, but here are some representative examples from Québec of general guidelines for specific cardiac conditions:
  • Angioplasty, stent: 24-48 hours after hospital discharge
  • Heart attack: 4 weeks
  • Open heart surgery: 4-6 weeks (longer if your sternum has not yet healed)
  • Heart failure, congenital heart disease, heart valve disease, cardiomyopathy: can vary depending on ongoing symptoms – consult your physician about the specifics of your diagnosis
  • Heart transplant: 6 weeks, depending on your physician’s assessment
  • Pacemaker: at least one week
  • Implantable cardioverter defibrillator (ICD): 3-6 months (plus you must report to your licensing regulator if your defibrillator has fired due to a cardiac arrhythmia, after which your driving restriction time will likely start over again)
  • Heart rhythm disorders: 1-6 months according to your physician’s assessment; depends on if your symptoms are under control, but driving is not advised if your condition causes you to lose consciousness or otherwise impairs driving ability

If you’re a commercial driver (e.g. a professional taxi, bus or truck driver), you will likely face even longer periods of driving restrictions following a cardiac event. In the UK, for example, where they appear to be very serious about this, guidelines updated in 2017 called Can I Drive if I Have a Heart Condition? warn of personal fines of up to £1,000 or legal prosecution if a patient fails to notify the local Driver and Vehicle Licensing Agency about a recent cardiac diagnosis before driving commercially.

Generally, before you drive again, you should always get your physician’s advice. You will probably be able to drive as long as:

  • you’re recovering well from your cardiac event or hospital procedure
  • cardiac symptoms are well under control
  • you don’t have any other condition that could also affect your driving
  • 1. Ysander L. “The Safety of Drivers with Chronic Disease.” British Journal of Industrial Medicine. 1966;23(1):28-36.
  • 2. Veldhuijzen et al., “Effect of chronic nonmalignant pain on highway driving performance”, Pain, 122(1-2):28–35. 2006.

Q:  Has your diagnosis affected your ability to drive? Have you ever had a close call while driving because of ongoing symptoms?

 See also:

 

14 Responses to “How soon are heart patients safely fit to drive?”

  1. autocreate740 July 10, 2017 at 2:40 pm #

    It took me a while after open heart surgery to feel comfortable in the driver’s seat. It was due to the sensitivity of my sternum. I would advise anyone to be careful after open heart surgery until the sternum is healed. For me, it was about 6 months.

    Liked by 1 person

    • Carolyn Thomas July 10, 2017 at 5:28 pm #

      YES! Good example, Judith – just because the doctor says “six weeks” doesn’t necessarily mean that you’ll feel ready to drive again in six weeks. We need to pay attention to what our bodies are telling us, individualy, not just to the calendar.

      Like

  2. Anne July 9, 2017 at 12:02 pm #

    You’d be surprised what altitude changes can do to people with heart damage. At sea level, I function as my new normal and driving is ….well…just the aggravation of gridlock.

    Except for the knowledge that if I were to have another heart event while stuck in gridlock on the highway, the ambulance will have a difficult time getting me into the heart cath facility to spare further tissue damage. So, I usually avoid heavy traffic – who needs it anyway!

    I found that while visiting cities at a higher elevation, I didn’t have chest pains or shortness of breath…but I did have an attention deficit. I found myself looking for oncoming traffic – as normal – but the delay in processing the information meant that it was easy to be too slow to pull into traffic. Being aware of the altitude impact meant that I needed to slow down and be more cautious with how I drive while at altitude. You kinda feel a little foggy thinking.

    Liked by 1 person

    • Carolyn Thomas July 9, 2017 at 3:45 pm #

      I hadn’t thought about altitude while driving, Anne! We do know that high altitude can increase both blood pressure and blood levels of stress hormones, so it’s not surprising that it might be associated with that “fuzzy thinking” too. I too prefer not to drive in heavy traffic (but it’s often easier to avoid predictable peak rush hour traffic than it is to avoid unexpected gridlock caused by road construction!) Maybe best to have a nice calming Enya CD in the car, I think…

      Like

      • Anne July 9, 2017 at 10:18 pm #

        I figured it was the reduction of oxygen to the brain and organs due to a weakened heart.

        Liked by 1 person

        • Carolyn Thomas July 9, 2017 at 11:48 pm #

          That’s what I’d expect, too, Anne – except that most guidelines on driving restrictions following diagnosis tend to be short-term while the patient’s body is adapting to new meds and healing (both physical and psychological, depending on the cardiac event) no matter what the altitude. If the “weakened heart” was a permanent situation, I’m guessing that would be a whole other issue.

          Like

  3. Lisa July 9, 2017 at 9:53 am #

    I had a major heart attack on a hiking trail where I lay for over an hour expecting to die before help arrived. I did not have surgery, only a stent, but I did not drive for a few weeks because my mind was not “present” a lot of the time. I was continually re-living the heart attack and did not have the concentration required for driving or many other things.

    My ability to concentrate and pay attention was the gauge I used to decide when to get behind the wheel of a car again.

    Liked by 2 people

    • Carolyn Thomas July 9, 2017 at 3:23 pm #

      Hello Lisa and thanks so much for bringing up this very important point. Being able to assess our own ability to concentrate – and then making the decision NOT to drive while impaired – is the key.

      By the way, I’m curious if your frightening heart attack experience while hiking made you hesitant to go hiking again?

      Like

      • Lisa July 9, 2017 at 5:28 pm #

        Yes, it sure has. I didn’t realize until you asked that I have avoided hiking since the heart attack. I finally joined a gym and I am going 3 mornings/week at 6AM (before I can wake up and think of an excuse not to go). The owner is also a trainer and he has given me a routine that is half conditioning and half strengthening. Now I don’t feel so guilty that I don’t want to hike right now. Maybe next year?

        Your scary driving experience reminds me of being an exhausted mother of young children and trying to think and drive while they were fighting in the back seat…. If people really knew what motherhood does to us, we would never be allowed to drive!

        Liked by 1 person

        • Carolyn Thomas July 9, 2017 at 6:39 pm #

          First of all, congrats on your early-morning gym workouts – good for you, and good for your heart. One of the reasons I asked is because of a study I read years ago about post-traumatic stress disorder following a catastrophic health crisis; researchers suggested that it is worsened if there’s an element of abandonment (e.g. you lying there believing you will die before help arrives). So, no wonder you’d prefer to put off hiking for the time being.

          I had to laugh out loud at your motherhood driving story! Reminds me of my sister who, many years ago when her three kids were little, kept a wooden spoon in the car so she could use it to reach back to whack one or more of them in the back seat when they started fighting – WHILE SHE WAS DRIVING. I know that smacking your kidlets with a wooden spoon is not at all funny, but honestly, that image of the harried Mum at the wheel trying to keep one eye on the traffic while one arm is waving indiscriminately behind her trying to make contact with screeching children now makes our family roar with laughter!

          Maybe we should extend these driving restrictions to exhausted mothers, too…?

          Like

  4. Deborah Walker July 9, 2017 at 8:48 am #

    When I consider the first six weeks after my open heart surgery, I know I wouldn’t have been able to do it: A-fib, very low blood pressure at one point, and other oddities. These all sorted themselves out and I went back to driving but I wouldn’t have dared doing so in the first six weeks. The main issue seems to be convincing some patients to keep off the road.

    BTW, I’ve heard that one of the reasons why we’re advised not to drive until the sternum is healed is because airbags can cause horrendous injury if they’re deployed. The scenario is: you pass out, hit the car in front of you and cause who-knows-what, then get injured by your own airbag. Have you heard this Carolyn or is it an urban myth?

    Liked by 1 person

    • Carolyn Thomas July 9, 2017 at 9:46 am #

      Hi Deborah! Thanks for this – your own story illustrates nicely how those 6-week driving restrictions might be only the starting point as long as debilitating symptoms persist!

      In answer to your airbag question, YES we do know that there at least three major cardiovascular problems linked to airbag deployment: aortic transection, tricuspid valve injury, and delayed cardiac rupture (not to mention an unhealed sternum – ouch!)

      I once read about the case of a women injured in a car accident who was then diagnosed with myocardial infarction (heart attack) because of significant changes to her EKG readings consistent with STEMI, that later turned out to be just a cardiac contusion caused by her airbag, not a heart attack at all. That’s how significant the damage caused by airbags can be.

      But to me, these cases just reinforce the real danger here, and that’s to the public. I think drivers should be at least as worried about hurting the poor innocent schmucks out there as they are about hurting their own unhealed sternums.

      Like

  5. Holly Shaltz July 9, 2017 at 6:04 am #

    I was never given any driving restrictions, either after developing severe congestive heart failure (CHF) symptoms, being placed on new meds that greatly affected blood pressure and cognition, after my ICD (implantable defibrillator) surgery, or after receiving a total of 6 stents in two procedures.

    But those meds caused unpredictable near-syncope episodes, particularly 10-15 minutes after eating lunch, so I placed myself on driving restrictions: Didn’t drive at all if it was in the 2 hours after a meal, and drove only very short distances at other times – and we live in the country, where there’s no highways or busy roads to contend with. My husband or a friend would drive me when needed, but I did stay home a lot!

    Thankfully I’m no longer on beta blockers (the cause of the near-syncope episodes), and my cognition and energy have improved as a result of that and other meds changes, plus my CHF is totally controlled for now. I’m enjoying being able to drive on good days, but I know it could change, and if so, I will make the responsible decision to not drive again. I don’t want to be the cause of an accident, even if no one is hurt.

    Holly

    Liked by 1 person

    • Carolyn Thomas July 9, 2017 at 8:16 am #

      Thank you Holly! It’s almost impossible to believe that not one physician gave you any instructions on driving restrictions given your significant diagnoses and symptoms! You were a responsible self-aware driver, but what about all the patients who aren’t like you? I’m happy to hear that your HF is nicely managed these days – enjoy your drive!

      Like

Your opinion matters. What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: