30% of ICD patients drive illegally after procedure

More than 30% of Danish heart patients with an implantable cardioverter-defibrillator (ICD) resume driving during a “banned period” following their index procedure, researchers reported at the ESC Congress in Paris on Sept. 3.

Study author Jenny Bjerre, of Gentofte University Hospital in Denmark, said the driving ban differs between countries, but the European Society of Cardiology recommends driving for personal use be banned for four weeks after ICD implantation for primary prevention, for three months after ICD implantation for secondary prevention and permanently for professional driving. If the ICD has the ability to deliver a shock to correct an arrhythmia, the driving ban also totals three months.

“It is the underlying heart condition and not the presence of the ICD device itself that is cause for concern, since it might cause an arrhythmia and loss of consciousness, and thus potentially great harm to the patient or bystanders if occurring while the patient is behind the wheel,” Bjerre said in a release. “That is why patients refusing to have an ICD implanted for secondary prevention are subject to driving restrictions as well.”

Bjerre and her team worked with subjects in Denmark, where the driving ban differs from other countries in that primary prevention ICD patients are allowed to drive after one week if they’re also on home-monitoring for their ICD. The researchers sent a questionnaire to 3,913 Danish adults who received a first-time ICD between 2013 and 2016, obtaining additional data from national registries.

Of 2,741 patients who responded to the survey, 2,513—92%—reported having a valid driving license at the time of ICD implantation. Another 7% said they had a license for driving heavy trucks or buses professionally. 

Up to 60% of the pool said they couldn’t recall being informed of any driving restrictions before their procedure, even though in Denmark, physicians are held responsible for letting their patients know if any procedure leads to a driving ban. More than 30% of patients, including those who drove professional vehicles, said they resumed driving during the banned period.

“Information is the key word here,” Bjerre said. “These driving restrictions are worthless if we do not tell patients about them. On the other hand, patients do not remember everything they are told, and if you have recently survived a cardiac arrest, driving restrictions might not be your biggest concern. Better communication is required, for example by repeating the information, but also in writing, explaining the rationale behind the restrictions and including family members in the discussions.”

She said men in the study were 50% more likely than women to drive while banned, and patients 60 years old and up were 20% more likely to drive than younger patients. Being the sole driver in the household was linked to a 30% greater likelihood of driving while banned, and patients who said they were unaware of the bans were, unsurprisingly, three times more likely to drive than those who said they were informed.

Bjerre said the penalty for driving while banned depends on national legislation. In Denmark, patients could be prosecuted or face insurance-related consequences if they’re involved in a traffic accident during a banned period, but since the Danish police aren’t automatically informed about medical driving bans, some ICD patients view it as a non-risk.

“We believe the necessity of a car in daily life is the most important factor [in nonadherence],” Bjerre said. “It is not hard to imagine an ICD patient might feel isolated, have trouble running errands, etc., during a period with driving restrictions, especially if they are older and living alone.”