3 - Cardiovascular Disease and Disorder

3.1About cardiovascular disease

Overview

Cardiovascular disease is an umbrella term used to describe a variety of disorders relating to the heart and blood vessels.

Coronary artery disease

Coronary artery disease, which is also called coronary, ischemic or atherosclerotic heart disease, is characterized by the presence of atherosclerosis in the arteries of the heart.

Atherosclerosis is the progressive buildup of fatty deposits called plaque, which narrows the coronary arteries and reduces blood flow to the heart. Complications of coronary artery disease include:

  • angina (pain or discomfort due to lack of oxygen to the heart muscle)
  • myocardial infarction (heart attack), and
  • ischemic cardiomyopathy (permanent damage to the heart muscle).

Disturbances of cardiac rhythm

Disturbances of cardiac rhythm, or arrhythmias, include:

  • tachycardia (rapid heart rate)
  • bradycardia (slow heart rate)
  • fibrillation or flutter (abnormal twitching of the heart muscle), and
  • heart block.

These arrhythmias may arise from the heart muscle itself or the conduction system and are often secondary to underlying heart disease.

Valvular heart disease

Disease affecting the heart valves may result in stenosis and regurgitation, and is associated with an increased risk of thromboembolism.

In valvular stenosis, the valve opening is smaller than normal due to hardening or fusing of the valve’s leaflets. This may cause the heart to have to work harder to pump blood through the valves. In valvular regurgitation or “leaky valve”, the valve does not close tightly enough, allowing some blood to leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body. Stenosis and regurgitation may coexist.

Individuals who have undergone valve replacement surgery are subject to a certain irreducible incidence of late complications such as thromboembolism, dehiscence, infection and mechanical malfunction.

Congestive heart failure

Congestive heart failure usually is a chronic, progressive condition in which the heart is unable to pump the quantity of blood required to meet the body's needs.  It is generally the result of heart disease but may be secondary to non-cardiac conditions such as fluid overload and anemia.

The severity of congestive heart failure can be assessed by measuring the fraction of blood being pumped out of the left ventricle with each beat. This is expressed as a ratio called the left ventricle ejection fraction (LVEF). Healthy individuals generally have an LVEF greater than 55%.

The New York Heart Association (NYHA) functional classification system provides a simple, clinical measure for assessing the degree of heart failure. This system describes the effect of cardiovascular disease on an individual’s general physical activity, according to the categories shown in the following table.

Category Description
I No symptoms and no limitation in ordinary physical activity. Comfortable at rest.
II Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
III Marked limitation in activity due to symptoms, even during less-than- ordinary activity. Comfortable only at rest.
IV Severe limitations. Experiences symptoms even while at rest.

Cardiomyopathy

Cardiomyopathy refers to a change in the size, strength or flexibility in the heart muscle. These changes can reduce the amount of blood being pumped out of the heart, and may lead to congestive heart failure. Cardiomyopathy is associated with an increased risk of arrhythmias.

3.2Prevalence

Cardiovascular disease is a major cause of death, disability and health care costs in Canada. Although cardiovascular disease death rates have been declining since the mid- 1960s, statistics from 1997 indicate that cardiovascular disease was still the leading cause of death in Canada, accounting for 36% of all deaths in men and 38% in women. As shown in the graph below, the proportion of deaths caused by cardiovascular disease increases dramatically with age.

percentage of total deaths due to cardiovascular disease

3.3Cardiovascular disease and adverse driving outcomes

Research indicates that drivers with cardiovascular disease as a whole have a higher risk for adverse driving outcomes than those without cardiovascular disease. However, there is relatively little research on the effects of specific cardiovascular disorders and driving outcomes.

3.4Effect of cardiovascular disease on functional ability to drive

Condition Type of driving impairment and assessment approach4 Primary functional ability affected Assessment tools

Coronary artery disease

Arrhythmias

Valvular heart disease

Cardiomyopathy

Episodic impairment: Medical assessment

– likelihood of impairment
All – sudden incapacitation Medical assessments
Congestive heart failure Persistent Impairment: Functional assessment

Can affect Motor Sensory and Cognitive function

May also result in general debility or lack of stamina

Medical assessments

Functional Assessment

Episodic impairment: Medical assessment

– likelihood of impairment
All – sudden incapacitation Medical assessments Specialist’s report

Post cardiac arrest

Post-operative cognitive decline (POCD)

Persistent Impairment: Functional assessment

Can affect Motor Sensory and Cognitive function

May also result in general debility

Medical assessments

Functional Assessment

4 See Part 1 for a discussion of the use of functional assessments for driver licensing decisions.

The effect of cardiovascular disease on an individual’s functional ability to drive may be episodic or persistent.

Episodic impairment

The potential episodic impairment is a partial or complete loss of consciousness that incapacitates the driver. This may be caused by a variety of cardiovascular events such as:

  • bradyarrhythmias
  • tachyarrhythmias
  • myocardial disease (massive myocardial infarction)
  • left ventricular myocardial restriction or constriction
  • pericardial constriction or tamponade
  • aortic outflow tract obstruction
  • aortic valvular stenosis, or
  • hypertrophic obstructive cardiomyopathy.

Persistent impairment

Individuals with congestive heart failure may develop persistent cognitive impairment, loss of stamina or general debility as a result of a reduction of oxygen to the brain, organs and tissues. Cardiac arrest also may cause persistent cognitive impairment where a loss of blood to the brain causes brain damage.

Neurocognitive deficits can occur in individuals undergoing intracardiac procedures (e.g. valve surgery) or extracardiac procedures (e.g. coronary artery bypass graft (CABG) surgery). However, the majority of studies investigating cognitive decline have focused on individuals undergoing CABG surgery. The results of those studies indicate that a significant number of individuals experience post-operative cognitive decline (POCD) for several months after surgery, with documented declines in memory, attention, speed of processing, and executive functioning. Studies indicate that between 20% and 79% of individuals experience POCD between 6 weeks and 6 months of CABG surgery, with a majority of the studies showing a rate of 45% or higher. In those studies that have followed individuals for more than 6 months post-surgery, the results indicate that up to 35% of individuals will show POCD one year after surgery. The current understanding is that POCD is the result of a number of factors associated with cardiac treatment, rather than a single factor such as the use of cardiopulmonary bypass.

3.5Compensation

Individuals with cardiovascular disease are not able to compensate for their functional impairment.

3.6Guidelines for assessment

These guidelines are based primarily on recommendations contained in the final report of the 2003 Canadian Cardiovascular Society (CCS) Consensus Conference Assessment of the Cardiac Patient for Fitness to Drive and Fly. The CCS recommendations focus exclusively on the potential episodic impairment associated with cardiovascular diseases.

Where the standards differ from the CCS recommendations, the rationale is included in the table.

For CCS recommendations for transient conditions (waiting periods) see Section 3.6.50 which form part of the standards.

3.6.1 Congenital heart defects

National Standard

All drivers eligible for a licence if

  • they meet any standards related to a specific cardiovascular condition or event
BC Guidelines

If further information regarding an individual’s medical condition is required,  RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or an
  • assessment from a cardiologist
Conditions for maintaining licence None
Reassessment
  • If the defect has been repaired and the treating physician does not indicate any concerns, no re-assessment, other than routine commercial or age-related re-assessment, is required.
  • If the defect has not been repaired, RoadSafetyBC will re-assess every 5 years, unless routine commercial or age-related re-assessment applies
Information from health care providers
  • Whether or not the defect has been repaired
  • Presence of any specific cardiovascular condition or event or risk of condition or event that may impair functional ability to drive
Rationale Congenital heart defects are not specifically addressed in the CCS recommendations. This standard is included here to assist where a congenital heart defect is reported to an authority. The nature of congenital heart defects and their treatment is variable; therefore there are no driver fitness standards specifically for them.

3.6.2 Acute Coronary Syndromes – Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • they have an angiographic demonstration of less than a 70% reduction in the diameter of the left main coronary artery, or
  • where they have a 70% or greater reduction in the diameter of the left main coronary artery, it has been successfully treated with revascularization
  • The waiting periods have been met (section 3.6.50)
BC Guidelines
  • If further information regarding an individual’s medical condition is required, RoadSafetyBC may request
    • a Driver’s Medical Examination Report
    • additional information from the treating physician, or
    • an assessment from a cardiologist.
  • RoadSafetyBC will not generally seek angiogram studies unless there is concern from treating physician.
  • RoadSafetyBC may find individuals fit to drive if
    • the applicable waiting periods are met (see 3.6.50);  OR
    • the above standard is met 
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess every five years, or as recommended by the treating physician, unless routine age-related re-assessment applies.
Information from health care providers
  • Extent of reduction in the left main coronary artery
  • Where applicable, result of treatment with revascularization
  • RoadSafetyBC will not generally seek above information or angiogram studies unless there is concern from treating physician
Rationale CCS recommendation

3.6.3 Acute Coronary Syndromes – Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • they have an angiographic demonstration of less than a 50% reduction in the diameter of the left main coronary artery, or
  • where they have a 50% or greater reduction in the diameter of the left main coronary artery, it has been successfully treated with revascularization
  • providing the applicable waiting periods are met (3.6.50)
BC Guidelines
  • If further information regarding an individual’s medical condition is required,  RoadSafetyBC may request
    • a Driver’s Medical Examination Report
    • additional information from the treating physician, or
    • an assessment from a cardiologist
  • RoadSafetyBC will not generally seek angiogram studies unless there is concern from treating physician
  • RoadSafetyBC may find individuals fit to drive if
    • the applicable waiting periods are met (see 3.6.50);  OR
    • the above standard is met 
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess in accordance with routine commercial re-assessment, or as recommended by the treating physician
Information from health care providers
  • Extent of reduction in the left main coronary artery
  • Where applicable, result of treatment with revascularization
  • RoadSafetyBC will not generally seek above information or angiogram studies unless there is concern from treating physician
Rationale CCS recommendation

3.6.4 Asymptomatic coronary artery disease or stable angina

National Standard All drivers eligible for a licence
BC Guidelines RoadSafetyBC will not generally request further information
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess every five years, unless routine  commercial or age-related re-assessment applies
Information from health care providers Confirmation that coronary artery disease is asymptomatic or angina is stable
Rationale CCS recommendation

3.6.5 CABG surgery – Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • it has been 1 month or more since CABG surgery

BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC  may request:

  • a Driver’s Medical Examination Report, or additional
  • information from the treating physician
Conditions for maintaining licence None
Reassessment

RoadSafetyBC will re-assess every five years, unless routine age-related re-assessment applies

Information from health care providers Date of CABG surgery
Rationale

CSS recommendations

3.6.6 CABG surgery – Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • it has been 3 months or more since CABG surgery

BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request:

  • a Driver’s Medical Examination Report, or
  • additional information from the treating physician
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess in accordance with routine commercial re-assessment, or as recommended by the treating physician.
Information from health care providers Date of CABG surgery
Rationale

CSS recommendations

3.6.7 Premature atrial or ventricular contractions

National Standard

All drivers eligible for a licence if

  • they have no associated impaired level of consciousness caused by cerebral ischemia
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request:

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment
  • if there is no underlying cardiovascular disease, no re-assessment is required, other than routine commercial or age related re-assessment
  • where there is an underlying cardiovascular disease, RoadSafetyBC will re-assess according to the guidelines for that condition
Information from health care providers Confirmation that there is no impaired level of consciousness caused by cerebral ischemia
Rationale CCS recommendation

3.6.8 Ventricular fibrillation with no reversible cause - Non-commercial drivers

This standard applies to non-commercial drivers who have ventricular fibrillation (VF) with no reversible cause. It does not apply to drivers who have VF due to any of the following reversible causes:

  • VF within 24 hours of myocardial infarction
  • VF during coronary angiography
  • VF with electrocution, or
  • VF secondary to drug toxicity.

If VF has a reversible cause, it is considered a transient condition, see 3.6.11.

National Standard

Non-commercial drivers eligible for a licence if

  • it has been 6 months or more since their last episode of ventricular fibrillation
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess every five years, or as recommended by the treating physician, unless routine age-related re-assessment applies
Information from health care providers Date of last episode of ventricular fibrillation
Rationale CCS recommendation

3.6.9 Ventricular fibrillation with no reversible cause – Commercial drivers

This standard applies to commercial drivers who have ventricular fibrillation (VF) with no reversible cause. It does not apply to drivers who have VF due to any of the following reversible causes:

  • VF within 24 hours of myocardial infarction
  • VF during coronary angiography
  • VF with electrocution, or
  • VF secondary to drug toxicity.

If VF has a reversible cause, it is considered a transient condition. The CCS recommendation for VF with a reversible cause is included in 3.6.11.

National Standard Commercial drivers not eligible for a licence
BC Guidelines RoadSafetyBC will not generally request further information
Conditions for maintaining licence N/A
Reassessment N/A
Information from health care providers N/A
Rationale CCS recommendation

3.6.10 Hemodynamically unstable VT – Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • It has been 6 months since the last episode, and
  • the underlying condition has been successfully treated
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request:

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist.
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess every five years or as recommended by the treating physician, unless routine age re-assessment applies
Information from health care providers Whether the underlying condition causing VT has been successfully treated
Rationale CCS recommendation

3.6.11 Hemodynamically unstable VT – Commercial drivers

National Standard Commercial drivers not eligible for a licence
BC Guidelines RoadSafetyBC will not generally request further information
Conditions for maintaining licence N/A
Reassessment N/A
Information from health care providers N/A
Rationale CCS recommendation

3.6.12 Sustained VT and a LVEF of <35% - Non-commercial drivers

This standard applies to non-commercial drivers who have sustained ventricular tachycardia (VT) with:

  • a left ventricular ejection fraction (LVEF) of <35% and
  • no associated impaired level of consciousness.

Sustained VT means VT having a cycle length of 500 msec or less, and lasting 30 seconds or more or causing hemodynamic collapse.

National Standard

Non-commercial drivers eligible for a licence if

  • it has been 3 months or more since their last episode of sustained VT
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or an assessment from a cardiologist

RoadSafetyBC may find individuals fit to drive if

  • it has been at least 3 months since their last episode, and
  • if they have not been treated with an implantable cardioverter defibrillator (ICD), an assessment by a cardiologist supports driving, or if they have been treated with an ICD must meet 3.6.27 requirements
Conditions for maintaining licence

RoadSafetyBC will impose the following condition on an individual who has been treated with an ICD and is found fit to drive

  • you must report to RoadSafetyBC if you  suffer an impaired level of consciousness or disability as a result of delivery of ICD therapy
Reassessment RoadSafetyBC will re-assess every five years, or as recommended by the treating physician, unless routine commercial or age-related re-assessment applies
Information from health care providers
  • Date of last episode of sustained VT
  • Whether treated with an implantable cardioverter defibrillator (ICD)
Rationale

CSS recommendations

3.6.13 Sustained VT and an LVEF of <35% Commercial drivers

This standard applies to commercial drivers who have sustained ventricular tachycardia (VT) with:

  • a left ventricular ejection fraction (LVEF) of <35% and
  • no associated impaired level of consciousness.

Sustained VT means VT having a cycle length of 500 msec or less, and lasting 30 seconds or more or causing hemodynamic collapse.

National Standard Commercial drivers not eligible for a licence
BC Guidelines RoadSafetyBC will not generally request further information
Conditions for maintaining licence N/A
Reassessment N/A
Information from health care providers N/A
Rationale  

3.6.14 Sustained VT and an LVEF of equal or >35% Non-commercial drivers

This standard applies to non-commercial drivers who have sustained ventricular tachycardia (VT):

  • with a left ventricular ejection fraction (LVEF) of equal or > 35%, with no associated impaired level of consciousness, and
  • for whom an implantable cardioverter defibrillator (ICD) has not been recommended.

Sustained VT means VT having a cycle length of 500 msec or less, and lasting 30 seconds or more or causing hemodynamic collapse.

National Standard

Non-commercial drivers eligible for a licence if

  • it has been 4 weeks or more since their last episode of sustained VT, and
  • they have been successfully treated with radiofrequency ablation plus a 1 week waiting period or successful pharmacological treatment
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess annually
Information from health care providers
  • Date of last episode of sustained VT
  • Whether the driver has been successfully treated
Rationale CCS recommendation

3.6.15 Sustained VT and an LVEF of equal or >35% Commercial drivers

This standard applies to commercial drivers who have sustained ventricular tachycardia (VT):

  • with a left ventricular ejection fraction (LVEF) of equal or >35% or equal
  • with no associated impaired level of consciousness, and
  • for whom an implantable cardioverter defibrillator (ICD) has not been recommended.

Sustained VT means VT having a cycle length of 500 msec or less, and lasting 30 seconds or more or causing hemodynamic collapse.

National Standard

Commercial drivers eligible for a licence if

  • it has been 3 months or more since their last episode of sustained VT, and
  • they have been successfully treated with radiofrequency ablation plus a 1 week waiting period or successful pharmacological treatment
BC Guidelines

If further information regarding an individual’s medical condition is required,  RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment

RoadSafetyBC will re-assess annually

Information from health care providers
  • Date of last episode of sustained VT
  • Whether the driver has been successfully treated
Rationale CCS recommendation

3.6.16 Non sustained VT

This standard applies to all drivers who have non-sustained ventricular tachycardia (VT).

Non-sustained VT means VT having a cycle length of 500 msec or less, and lasting less than 30 seconds without hemodynamic collapse.

National Standard All drivers eligible for a licence
BC Guidelines RoadSafetyBC will not generally request further information
Conditions for maintaining licence None
Reassessment If there is no underlying cardiovascular disease, no re-assessment is required, other than routine commercial or age-related re-assessment. Where there is an underlying cardiovascular disease, RoadSafetyBC will re-assess according to the guidelines for that condition
Information from health care providers None
Rationale CCS recommendation

3.6.17 Paroxysmal SVT, AF or AFL with no impaired consciousness

This standard applies to all drivers who have had paroxysmal:

  • supraventricular tachycardia (SVT)
  • atrial fibrillation (AF), or
  • atrial flutter (AFL)

with no associated impaired level of consciousness.

National Standard All drivers eligible for a licence
BC  Guidelines RoadSafetyBC will not generally request further information
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess in five years. If there have been no further occurrences at that time, no further re-assessment is required, unless routine commercial or age-related re-assessment applies
Information from health care providers None
Rationale CCS recommendation

3.6.18 Paroxysmal SVT, AF or AFL with impaired consciousness

This standard applies to all drivers who have had paroxysmal:

  • supraventricular tachycardia (SVT)
  • atrial fibrillation (AF), or
  • atrial flutter (AFL)

with an associated impaired level of consciousness.

National Standard

All drivers eligible for a licence if

  • they have been on medical therapy for a minimum of 3 months with no recurrence of paroxysmal SVT, AF, or AFL with impaired level of consciousness
  • for drivers with paroxysmal SVT, it has been successfully treated with radiofrequency ablation
  • for drivers with paroxysmal AF, they have had AV node ablation and pacemaker implantation and meet the standard for pacemaker treatment, and
  • for drivers with paroxysmal AFL, they have had a successful isthmus ablation with proven establishment of bidirectional isthmus block
BC  Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess in five years.  If there have been no further occurrences at that time, no further re-assessment is required, unless routine commercial or age-related re-assessment applies.  For individuals who have had pacemaker implantation, the re-assessment guidelines under 3.6.23 and 3.6.24 apply
Information from health care providers
  • Date of last occurrence of paroxysmal SVT, AF, or AFL with impaired level of consciousness
  • For drivers with paroxysmal SVT, whether it has been successfully treated with radiofrequency ablation
  • For drivers with paroxysmal AF, whether they have had AV node ablation and pacemaker implantation
  • For drivers with paroxysmal AFL, whether they have had a successful isthmus ablation with proven establishment of bidirectional isthmus block
Rationale CCS recommendation

3.6.19 Persistent or permanent paroxysmal SVT, AF or AFL

This standard applies to all drivers who have persistent or permanent paroxysmal:

  • supraventricular tachycardia (SVT)
  • artial fibrillation (AF), or atrial flutter (AFL).
National Standard

All drivers eligible for a licence if

  • they have adequate ventricular rate control, and
  • they do not experience an impaired level of consciousness
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request:

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess every five years, or as recommended by the treating physician, unless routine age-related re-assessment applies
Information from health care providers
  • Whether the driver has adequate ventricular rate control
  • Whether the driver experiences an impaired level of consciousness
Rationale CCS recommendation

3.6.20 Sinus node dysfunction

National Standard

All drivers eligible for a licence if

  • they have no associated symptoms, or
  • where they have associated symptoms, the sinus node dysfunction has been successfully treated with a pacemaker and they meet the standard for pacemaker treatment
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request:

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess every five years, unless routine commercial or age-related re-assessment applies
Information from health care providers
  • Whether the driver has associated symptoms
  • Where the driver has associated symptoms, whether they have been successfully treated with a pacemaker
Rationale CCS recommendation

3.6.21 Atrioventricular (AV) or intraventricular block – Non-commercial drivers

If a permanent pacemaker is implanted, the recommendations in 3.6.23 prevail.

National Standard
  • Non-commercial drivers with
    • isolated first degree AV block
    • isolated right bundle branch block (RBBB), or
    • isolated left anterior or posterior fascicular block are eligible for a licence
  • Non-commercial drivers with
    • left bundle branch block (LBBB)
    • bifascicular block
    • second degree AV block/Mobitz I
    • first degree AV block + bifascicular block, or congenital third degree AV block are eligible for a licence if
      • they have had no associated impaired level of consciousness
  • Non-commercial drivers with
    • second degree AV block; Mobitz II (distal AV block)
    • alternating LBBB and RBBB, or
    • acquired third degree AV block are not eligible for a licence

 *** For each of these scenarios; if a permanent pacemaker is implanted, the recommendations in 3.6.23 prevail

BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request:

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess every five years, unless routine commercial or age related re-assessment applies
Information from health care providers
  • The specific nature of the atrioventricular or intraventricular block
  • Where the driver has
    • left bundle branch block (LBBB)
    • bifascicular block
    • second degree AV block/Mobitz I
    • first degree AV block + bifascicular block, or
    • congenital third degree AV block
  • whether the driver has had any associated impaired level of consciousness
  • whether a permanent pacemaker is implanted
Rationale CCS recommendation

3.6.22 Atrioventricular (AV) or intraventricular block - Commercial drivers

If a permanent pacemaker is implanted, the recommendations in 3.6.24 prevail.

National Standard
  • Commercial drivers with
    • isolated first degree AV block
    • isolated right bundle branch block (RBBB), or
    • isolated left anterior or posterior fascicular block are eligible for a licence
  • Commercial drivers with
    • left bundle branch block (LBBB)
    • bifascicular block
    • second degree AV block/Mobitz I, or
    • first degree AV block + bifascicular block eligible for a licence if
      • they have had no associated impaired level of consciousness, and
      • the conditions for maintaining a licence are met
  • Commercial drivers with a congenital third degree AV block are eligible for a licence if
    • they have had no associated impaired level of consciousness
    • they have a QRS duration < 110 msec, and
    • they have a Holter showing no documented pauses > 3 seconds
    • the conditions for maintaining a licence are met
  • Commercial drivers with
    • second degree AV block; Mobitz II (distal AV block)
    • alternating LBBB and RBBB, or
    • acquired third degree AV block are not eligible for a licence

***For each of the scenarios, if a permanent pacemaker is implanted 3.6.24 prevail.

BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess in accordance with routine commercial re-assessment
Information from health care providers
  • The specific nature of the atrioventricular or intraventricular block
  • Where the driver has
    • left bundle branch block (LBBB)
    • bifascicular block
    • second degree AV block/Mobitz I
    • first degree AV block + bifascicular block, or
    • congenital third degree AV block
  • whether the driver has had any associated impaired level of consciousness and the results of Holter confirming no higher grade AV block
  • Where the driver has had congenital third degree AV block, whether they have a QRS duration <110 msec and the results of a Holter showing no documented pauses >3 seconds
Rationale CCS recommendation

3.6.23 Permanent pacemakers - Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • It has been 1 week or more since pacemaker implant
  • They have not experienced any episodes of impaired level or consciousness since the implant
  • They show normal sensing and capture on a post-implant ECG, and
  • The conditions for maintaining a licence are met
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess every five years, unless routine age-related re-assessment applies
Information from health care providers
  • Whether the driver has experienced any episodes of impaired level of consciousness since the implant
  • Whether the results of a post-implant ECG show normal sensing and capture
Rationale CCS recommendation

3.6.24 Permanent pacemakers - Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • it has been 1 month or more since pacemaker implant
  • they have not experienced any episodes of impaired level of consciousness since the implant
  • they show normal sensing and capture on a post-implant ECG, and
  • the conditions for maintaining a licence are met
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess in accordance with routine commercial re-assessment
Information from health care providers
  • Date of pacemaker implant
  • Whether the driver has experienced any episodes of impaired level of consciousness since the implant
  • Whether the results of a post-implant ECG show normal sensing and capture
Rationale CCS recommendation

3.6.25  Declined an ICD or have an ICD implanted as primary prophylaxis – Non- commercial drivers

This standard applies to non-commercial drivers who:

  • have had an implantable cardioverter defibrillator (ICD) implanted as a primary prophylaxis, or
  • have declined an ICD recommended as primary prophylaxis

When implanted as a primary prophylaxis, the ICD is implanted to prevent sudden cardiac death in individuals considered to be at high risk but who have not had an episode of ventricular arrhythmia.

Individuals whose ICD also regulates pacing for bradycardia must also meet the standard for permanent pacemakers in 3.6.23.

National Standard

Non-commercial drivers eligible for a licence if

  • they are assessed as NYHA Class I, II, or III
  • it has been 4 weeks or more since ICD implant (if applicable), and
  • the conditions for maintaining a licence are met (if applicable)
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence
  • Regularly check ICD at a device clinic and do not drive if there is an ICD malfunction
  • Report to the authority if you experience an impaired level of consciousness or disability as a result of ICD therapy
Reassessment

If the individual’s condition is controlled and stable, RoadSafetyBC will re-assess every five years, unless a shorter period is recommended by the treating physician or routine age-related re-assessment applies

Information from health care providers
  • NYHA classification
  • Date of ICD implant (if applicable)
Rationale CCS recommendation

3.6.26 Declined an ICD or have an ICD implanted as primary prophylaxis – Commercial drivers

This standard applies to commercial drivers who:

  • have had an implantable cardioverter defibrillator (ICD) implanted as a primary prophylaxis, or
  • have declined an ICD recommended as primary prophylaxis

When implanted as a primary prophylaxis, the ICD is implanted to prevent sudden cardiac death in individuals considered to be at high risk but who have not had an episode of ventricular arrhythmia.

Individuals whose ICD also regulates pacing for bradycardia must also meet the standard for permanent pacemakers in 3.6.24.

National Standard

Commercial drivers generally not eligible for a licence. May be eligible if

  • cardiologist assessment indicates that the annual risk of sudden incapacitation is 1% or less, and
  • the driver meets the standard for ICD implanted as a primary prophylaxis in non-commercial drivers 3.6.25
BC Guidelines If further information regarding an individual’s medical condition is required, RoadSafetyBC will request an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess annually
Information from health care providers Cardiologist’s assessment  that the annual risk of sudden incapacitation is 1%  per CCS recommendation
Rationale CCS recommendation – an ICD may sometimes be implanted in low risk patients. Individual cases may be made for allowing a commercial driver to continue driving with an ICD provided the annual risk of sudden incapacitation is felt to be 1% or less

3.6.27 ICD implanted as secondary prophylaxis for sustained VT – Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence

  • if they are assessed as NYHA Class I, II, or III
  • it has been 1 week or more since ICD implant
  • it has been 3 months or more since their last episode of sustained VT, and
  • the conditions for maintaining a licence are met
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or an assessment from a cardiologist
Conditions for maintaining licence
  • Regularly check ICD at a device clinic and do not drive if there is an ICD malfunction
  • Report to the authority if you experience an impaired level of consciousness or disability as a result of ICD therapy
Reassessment If the individual’s condition is controlled and stable, RoadSafetyBC will re-assess every five years, unless a shorter period is recommended by the treating physician or routine age-related re-assessment applies
Information from health care providers
  • NYHA classification
  • Date of ICD implant
  • Date of last episode of sustained VT
  • Had driver experienced an impaired level of consciousness since ICD implant
Rationale CCS recommendation

3.6.28 ICD implanted as secondary prophylaxis for sustained VT - Commercial drivers

National Standard Commercial drivers not eligible for a licence
BC Guidelines N/A
Conditions for maintaining licence N/A
Reassessment N/A
Information from health care providers N/A
Rationale CCS recommendation

3.6.29 ICD therapy (shock or ATP) has been delivered - Non-commercial drivers

This standard applies to non-commercial drivers where ICD therapy (shock or ATP) has been delivered and there is an associated impaired level of consciousness, or the therapy delivered by the device was disabling.


National Standard

Non-commercial drivers eligible for a licence if

  • it has been 6 months or more since the event, and
  • the standard for the underlying cardiovascular condition are met
BC Guidelines

Non-commercial drivers eligible for a licence if

  • it has been 6 months or more since the event, and
  • the standard for the underlying cardiovascular condition are met
Conditions for maintaining licence As per the standard for the underlying cardiovascular condition
Reassessment As per the standard for the underlying cardiovascular condition
Information from health care providers Date of the event
Rationale CCS recommendation

3.6.30 ICD therapy (shock or ATP) has been delivered - Commercial drivers

National Standard Commercial drivers are ineligible for a licence
BC Guidelines

N/A

Conditions for maintaining licence N/A
Reassessment N/A
Information from health care providers N/A
Rationale CCS recommendation

3.6.31 ICD Implanted as secondary prophylaxis for VF or VT - Non-commercial drivers

This standard applies to non-commercial drivers who have had an implantable cardioverter defibrillator (ICD) implanted as a secondary prophylaxis for VF or VT with an impaired level of consciousness.

When implanted as a secondary prophylaxis, the ICD is implanted to prevent sudden cardiac death in individuals who have suffered a cardiac arrest or who suffer from malignant arrhythmias that do not respond readily to medical treatment.

Individuals whose ICD also regulates pacing for bradycardia must also meet the standard for permanent pacemakers in 3.6.23.

National Standard

Non-commercial drivers eligible for a licence

  • if assessed as NYHA class I, II, III
  • it has been 6 months or more since their last episode of sustained symptomatic VT or syncope judged to be likely due to VT or cardiac arrest, and
  • the conditions for maintaining a licence are met
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence
  • Regularly check ICD at a device clinic and do not drive if there is an ICD malfunction
  • Report to the authority if you experience an impaired level of consciousness or disability as a result of ICD therapy
Reassessment

If the individual’s condition is controlled and stable, RoadSafetyBC will re-assess every five years, unless a shorter period is recommended by the treating physician or routine age-related re-assessment applies

Information from health care providers Date of last episode of sustained symptomatic VT or syncope judged to be likely due to VT or cardiac arrest
Rationale CCS recommendation

3.6.32 ICD implanted as secondary prophylaxis for VF or VT – Commercial drivers

National Standard Commercial drivers not eligible for a licence
BC Guidelines

N/A

Conditions for maintaining licence N/A
Reassessment N/A
Information from health care providers N/A
Rationale CCS recommendation

3.6.33 Inherited heart disease – Non-commercial drivers

This standard applies to non-commercial drivers with the following inherited heart diseases:

  • Brugada’s Syndrome
  • Long QT Syndrome, and
  • arrhythmogenic right ventricular cardiomyopathy.
National Standard

Commercial drivers generally not eligible for a licence. May be eligible if

  • an assessment by a cardiologist indicates that the annual risk of sudden incapacitation is 1% or less, and
  • the driver meets the standard for inherited heart disease in non-commercial drivers
BC Guidelines If further information regarding an individual’s medical condition is required, RoadSafetyBC will request an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess annually
Information from health care providers Cardiologist’s assessment which indicates that the annual risk of sudden incapacitation is 1% or less
Rationale CCS recommendation – Inherited heart diseases may sometimes be identified to pose a very low risk to patients. Individual cases can sometimes be made to allow a commercial driver to continue to drive despite the diagnosis of one of these diseases, provided the annual risk of sudden incapacitation is believed to be less than one percent

3.6.34  Inherited heart disease – Commercial drivers

National Standard

Commercial drivers generally not eligible for a licence. May be eligible if

  • an assessment by a cardiologist indicates that the annual risk of sudden incapacitation is 1% or less, and
  • the driver meets the standard for inherited heart disease in non-commercial drivers
BC Guidelines If further information regarding an individual’s medical condition is required, RoadSafetyBC will request an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess annually
Information from health care providers Cardiologist’s assessment which indicates that the annual risk of sudden incapacitation is 1% or less
Rationale CCS recommendation – Inherited heart diseases may sometimes be identified to pose a very low risk to patients. Individual cases can sometimes be made to allow a commercial driver to continue to drive despite the diagnosis of one of these diseases, provided the annual risk of sudden incapacitation is believed to be less than one percent

3.6.35  Medically treated valvular heart disease – Non-commercial drivers

This standard applies to non-commercial drivers with medically treated:

  • aortic stenosis
  • aortic regurgitation
  • mitral stenosis, or
  • mitral regurgitation.
National Standard

Non-commercial drivers eligible for a licence if

  • they are assessed as NYHA Class I or II, and
  • they have had no episodes of impaired level of consciousness
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment

RoadSafetyBC will re-assess every five years, unless routine age-related re-assessment applies

Information from health care providers
  • NYHA classification
  • Whether the driver has had an episode of impaired level of consciousness
Rationale CCS recommendation

3.6.36  Medically treated aortic stenosis or aortic sclerosis – Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • they are assessed as NYHA Class I
  • their condition is asymptomatic
  • they have an aortic valve area (AVA) ) > 1.0 cm2
  • they have a left ventricle ejection fraction (LVEF) > 35%
  • they have had a detailed assessment by a cardiologist, including an assessment for risk of syncope, and
  • the conditions for maintaining a licence are met
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence Have an annual medical follow-up
Reassessment

RoadSafetyBC will re-assess annually

Information from health care providers
  • NYHA classification
  • Whether condition is asymptomatic
  • Aortic Valve Area (AVA)
  • Left ventricle ejection fraction (LVEF)
  • Confirmation of cardiologist assessment including risk of syncope
Rationale CCS recommendation

3.6.37  Medically treated aortic or mitral regurgitation or mitral stenosis – Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • they are assessed as NYHA Class I
  • they have a left ventricle ejection fraction (LVEF) equal or greater than 35%
  • they have had no episodes of impaired level of consciousness
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment

RoadSafetyBC will re-assess in accordance with routine commercial re-assessment

Information from health care providers
  • NYHA classification
  • Left ventricle ejection fraction (LVEF)
  • Whether the driver has had an episode of impaired level of consciousness
Rationale CCS recommendation

3.6.38 Surgically treated valvular heart disease – Non-commercial drivers

This standard applies to non-commercial drivers with:

  • mechanical prostheses
  • mitral bioprostheses with non-sinus rhythm
  • mitral valve repair with non-sinus rhythm
  • aortic bioprostheses
  • mitral bioprostheses with sinus rhythm, or
  • mitral valve repair with sinus rhythm.
National Standard

Non-commercial drivers eligible for a licence if

  • it has been 6 weeks or more since their discharge following treatment
  • they have no thromboembolic complications, and
  • for drivers with mechanical prostheses, mitral bioprostheses with non-sinus rhythm or mitral valve repair with non-sinus rhythm, they are on anti-coagulant therapy
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess every five years, unless routine age-related re-assessment applies
Information from health care providers
  • Type of surgical treatment
  • Date of their discharge following treatment
  • Whether there are thromboembolic complications
  • Where applicable, whether the driver is on anti-coagulant therapy
Rationale CCS recommendation

3.6.39 Surgically treated valvular heart disease – Commercial drivers

This standard applies to commercial drivers with:

  • mechanical prostheses
  • mitral bioprostheses with non-sinus rhythm
  • mitral valve repair with non-sinus rhythm
  • aortic bioprostheses
  • mitral bioprostheses with sinus rhythm, or
  • mitral valve repair with sinus rhythm.
National Standard

Commercial drivers eligible for a licence if

  • it has been 3 months or more since their discharge following treatment
  • they have no thromboembolic complications
  • they are assessed as NYHA Class I
  • they have an LVEF > 35%, and
  • for drivers with mechanical prostheses, mitral bioprostheses with non-sinus rhythm or mitral valve repair with non-sinus rhythm, they are on anti-coagulant therapy
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess in accordance with routine commercial re-assessment
Information from health care providers
  • Type of surgical treatment
  • Date of their discharge following treatment
  • Whether there are thromboembolic complications
  • NYHA classification
  • Left ventricle ejection fraction (LVEF)
  • Where applicable, whether the driver is on anti-coagulant therapy
Rationale CCS recommendation

3.6.40  Mitral valve prolapse – All drivers  

National Standard

All drivers eligible for a licence if

  • they are asymptomatic, or
  • where they are symptomatic they have been assessed for arrhythmia and they meet any applicable standard for arrhythmia
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report;
  • additional information from the treating physician; or
  • assessment from a cardiologist
Conditions for maintaining licence None
Reassessment Where the condition is longstanding and asymptomatic, RoadSafetyBC will re-assess every five years, unless routine commercial or age-related re-assessment applies
Information from health care providers Whether the driver is asymptomatic
Rationale CCS recommendation

3.6.41 Congestive heart failure - Non-commercial drivers

If using left ventricular assist device (LVAD), see 3.6.43

National Standard

Non-commercial drivers eligible for a licence if

  • they are assessed as NYHA Class I, II, or III
  • they are not receiving intermittent inotropes
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist

RoadSafetyBC may find individuals fit to drive if

  • they meet above standards,  or
  • if the treating physician indicates possible impairment of one or more of the functions necessary for driving, RoadSafetyBC will request functional assessment(s) as appropriate for the type(s) of impairment and class of licence held, unless there has been no significant change in the individual’s condition or functional ability since a previous functional assessment
Conditions for maintaining licence None
Reassessment

RoadSafetyBC will re-assess every 5 years or in accordance with routine age-related re-assessment, unless more frequent re-assessment is recommended by the treating physician

Information from health care providers
  • NYHA Classification
  • Whether the driver is receiving intermittent inotropes or using a left ventricle assist device
  • Results of cognitive screening
Rationale CCS recommendations

3.6.42 Congestive heart failure - Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • they are assessed as NYHA Class I or II
  • they have an LVEF of > 35%
  • they are not receiving intermittent inotropes
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist.

RoadSafetyBC may find individuals fit to drive if

  • they meet above standards; and
  • they are not using a left ventricle assist device
  • If the treating physician indicates possible impairment of one or more of the functions necessary for driving, RoadSafetyBC will request functional assessment(s) as appropriate for the type(s) of impairment and class of licence held, unless there has been no significant change in the individual’s condition or functional ability since a previous functional assessment
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess in accordance with routine commercial re-assessment, unless more frequent re-assessment is recommended by the treating physician
Information from health care providers
  • NYHA Classification
  • LVEF
  • Whether the driver is receiving intermittent inotropes or using a left ventricle assist device
Rationale CSS recommendations

3.6.43 Left ventricular dysfunction or cardiomyopathy – Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • they are assessed as NYHA Class I, II, or III
  • they are not receiving intermittent inotropes, and
  • if has left ventricular assist device (LVAD) and cardiologist report indicates is stable for 2 months post implantation
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist

If has left ventricular assist device (LVAD), RoadSafetyBC may find individuals fit to drive if

  • they meet standard above; and
  • they have a continuous flow LVAD implanted
  • if the treating physician indicates possible impairment of one or more of the functions necessary for driving, RoadSafetyBC will request functional assessment(s) as appropriate for the type(s) of impairment and class of licence held, unless there has been no significant change in the individual’s condition or functional ability since a previous functional assessment
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess every 5 years or in accordance with routine age- related re-assessment, unless more frequent re-assessment is recommended by the treating physician
Information from health care providers
  • NYHA Classification
  • Whether the driver is receiving intermittent inotropes or using an LVAD
  • Date and Type of LVAD implant
Rationale CCS recommendation  These guidelines are consistent with the 2012 CCS Position Statement Update on Assessment of the Cardiac Patient for Fitness to Drive: Fitness Following Left Ventricular Assist Device Implantation

3.6.44 Left ventricular dysfunction or cardiomyopathy - Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • they are assessed as NYHA Class I or II
  • they have an LVEF of equal or > 35%
  • they are not receiving intermittent inotropes, and
  • they are not using a left ventricle assist device
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment RoadSafetyBC will re-assess in accordance with routine commercial re-assessment, unless more frequent re-assessment is recommended by the treating physician
Information from health care providers
  • NYHA Classification
  • Left ventricle ejection fraction (LVEF)
  • Whether the driver is receiving intermittent inotropes or using a left ventricle assist device
Rationale CCS recommendation These guidelines are consistent with the 2012 CCS Position Statement Update on Assessment of the Cardiac Patient for Fitness to Drive: Fitness Following Left Ventricular Assist Device Implantation

3.6.45 Heart transplant – Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • it has been 6 weeks or more since their discharge following transplant
  • they are assessed as NYHA Class I or II
  • they are on stable immunotherapy, and
  • they meet the conditions for maintaining a licence
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess every 5 years if the individual’s condition is controlled, stable and asymptomatic. Otherwise, RoadSafetyBC will re-assess as recommended by the treating physician
Information from health care providers
  • Date of the driver’s discharge following transplant
  • NYHA Classification
  • Whether the driver is on stable immunotherapy
Rationale CCS recommendation

3.6.46 Heart transplant - Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • it has been 6 months or more since their discharge following transplant
  • they are assessed as NYHA Class I
  • they have an LVEF of equal or > 35%
  • they are on stable immunotherapy
  • they have no active ischemia, and
  • they meet the conditions for maintaining a licence
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment

RoadSafetyBC will re-assess in accordance with routine commercial re-assessment, unless more frequent re-assessment is recommended by the treating physician

Information from health care providers
  • Date of the driver’s discharge following the transplant
  • NYHA Classification
  • Left ventricle ejection fraction (LVEF)
  • Whether the driver is on stable immunotherapy
  • Whether the driver has active ischemia
Rationale CCS recommendation

3.6.47 Hypertrophic cardiomyopathy - Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • they have had no episodes of impaired level of consciousness
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence None
Reassessment

RoadSafetyBC will re-assess annually until the condition is controlled and stable and then every five years, unless routine age-related re-assessment applies

Information from health care providers Whether the driver has had an episode of impaired level of consciousness
Rationale CCS recommendation

3.6.48 Hypertrophic cardiomyopthy - Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • they have had no episodes of impaired level of consciousness
  • they have no family history of sudden death at a young age
  • they have left ventricle wall thickness of < 30 mm
  • they show no increase in blood pressure with exercise, and
  • they have no non-sustained VT
BC Guidelines

If further information regarding an individual’s medical condition is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report
  • additional information from the treating physician, or
  • an assessment from a cardiologist
Conditions for maintaining licence No conditions are required
Reassessment RoadSafetyBC will re-assess annually until the condition is controlled and stable and then in accordance with routine commercial re-assessment
Information from health care providers
  • Whether the driver has had an episode of impaired level of consciousness
  • Whether the driver has a family history of sudden death at a young age
  • Whether the driver’s left ventricle wall thickness is < 30 mm
  • Whether the driver shows an increase in blood pressure with
  • exercise
  • Whether the driver has any nonsustained VT on a Holter
Rationale CCS recommendation

3.6.49   Syncope

The standards for syncope are included in Chapter 19.

3.6.50 CCS recommendations regarding transient conditions (Waiting Periods)

The waiting periods in these recommendations form part of the standard and refer to the time interval following onset of the referenced cardiac condition or event during which it is recommended that an individual does not drive.  These standards are intended to mitigate the risk of an episodic impairment of functional ability to drive.

  • Recurrence of the referenced cardiac condition or event during a waiting period resets the waiting period.
  • If more than one waiting period applies (because of multiple conditions/events) the longer waiting period should be applied, unless otherwise stated.

A.Coronary artery disease

Acute coronary syndromes – waiting periods

Condition Classes 5-7 Non commercial Classes 1-4 Commercial
ST elevation MI 1 month after discharge
 
3 months after discharge
 
Non-ST elevation MI with significant LV damage

Non-ST elevation MI with minor LV damage

If PCI performed during initial hospital stay

48 hours after PCI 7 days after PCI

If PCI not performed during initial hospital stay

7 days after discharge 30 days after discharge

Acute coronary syndrome without MI (unstable angina)

If PCI performed during initial hospital stay

48 hours after PCI 7 days after PCI

If PCI not performed during initial hospital stay

7 days after discharge 30 days after discharge

Notes:

ST elevation: refers to the appearance of the ST segment of an electrocardiogram (ECG or EKG)

MI:  Myocardial infarction (heart attack) LV:  left ventricle

Significant LV damage:  any MI which is not classified as minor

Minor LV damage: an MI defined only by elevated troponin + ECG changes and in the absence of a new wall motion abnormality.

Stable coronary syndromes – waiting periods

  Non-Commercial Commercial

Stable angina

No restrictions
Asymptomatic coronary artery disease
PCI 48 hours after PCI 7 days after PCI

Notes:

PCI:  Percutaneous coronary intervention (angioplasty)

Cardiac surgery for coronary artery disease – waiting periods

  Non-commercial Commercial
Coronary artery bypass graft 1 month after discharge 3 months after discharge

B. Disturbances of cardiac rhythm, arrhythmia devices and procedures

Catheter ablation and EPS

  Non-commercial Commercial

Catheter ablation procedure

EPS with no inducible sustained ventricular

48 hours after discharge 1 week after discharge

Notes:

EPS: electrophysiology

 Disturbances of cardiac rhythm and arrhythmia devices

Ventricular arrhythmias

  Non-commercial Commercial
VF with a reversible cause No driving until/unless successful treatment of underlying conditions

Notes:

VF:  ventricular fibrillation Examples of reversible causes of VF:

  • VF within 24 hours of myocardial infarction
  • VF during coronary angiography
  • VF with electrocution
  • VF secondary to drug toxicity