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Advice for medical professionals to use when assessing drivers with cardiovascular disorders.
For Group 2 licensing, if there is evidence of obstructive coronary artery disease on invasive or CT angiography or myocardial ischaemia on functional testing but it does not fall under any of the categories above, those individuals would need to meet the functional test requirements.
In all cases of ICD implanted for sustained ventricular arrhythmia associated with incapacity, driving must stop for 6 months from the date of ICD implantation and any resumption requires:
ICD implantation is a permanent bar to Group 2 licensing. In all cases of ICD implantation (including prophylactic ICD implantation) driving must stop permanently and:
All patients must have regular medical review.
Note: for Group 2 cases, the exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm.
*The exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm.
Note: Assess risk factors for aortic dissection for all drivers with bicuspid aortopathy*
*Risk factors for dissection include:
Coarctation of aorta
Family history of dissection
Documented increase in aortic diameter greater than 3mm/year
Note: ‘satisfactory control of blood pressure’ means clinically relevant to aortic dissection, not the DVLA standard for hypertension.
Note: Assess risk factors for aortic dissection for all drivers with Marfan syndrome*
*Risk factors include:
Family history of aortic dissection
Severe aortic or mitral regurgitation
Greater than 3mm per year increase than aneurysm diameter
Note: DVLA bars Group 2 bus and lorry licensing when left ventricular ejection fraction is less than 40%.
Also refer to the following sections in this document:
Refer to NYHA classification detailed below.
The New York Heart Association (NYHA) classification is used to grade the severity of functional limitations in a patient with heart failure (1):
See Appendix C for the definition of ‘severe’ asymptomatic aortic stenosis.
*See classification of congenital heart disease complexity and the section in Appendix C.
For syncope, refer to Chapter 1.
* corrected QT interval
Aortic aneurysm (including bicuspid aortopathy, aortic dissection, Marfan Syndrome and other inherited aortopathies) – clarification of standards Hypertrophic cardiomyopathy – interpretation of ECG changes during exercise testing (Appendix C) Congenital heart disease – referencing of classification of complexity of congenital heart disease
Acute Coronary Syndrome – Title amended to include Takotsubo cardiomyopathy and clarification of Group 2 standard for Takotsubo cardiomyopathy Marfan Syndrome and other inherited aortopathies – Group 1 standard amended to reference surgical treatment Pulmonary Arterial Hypertension – Title of standard amended to “Pulmonary arterial hypertension (including chronic thromboembolic pulmonary hypertension) – an established diagnosis (under the care of a specialist centre) Hypertrophic cardiomyopathy (HCM) – Amendment of Group 2 standard Pacemaker – Clarification of Group 2 standards for pacemaker implant and pacemaker box change Aortic stenosis – Clarification of Group 1 standard for symptomatic aortic stenosis
Introduction of new standard for catheter ablation. Clarification of standard for Implantable Cardioverter Defibrillator (ICD). Clarification of standard for pacemaker implant versus box or battery change. Definition of the term ‘incapacity’. Clarification of the standard regarding pulmonary hypertension – an established diagnosis.
Guidance for both Group 1 and Group 2 symptomatic heart valve disease has been clarified
Categorisation of myocardial infarction into Type and Type 2 infarction. Clarification regarding coronary artery disease and Group 2 driving.
Changes to ‘Arrhythmia’ and ‘Implantable cardioverter defibrillator’ sections. Inclusion of standards for pulmonary hypertension.
As a consequence of both panel review and upcoming changes to European legislation, several changes have been made to this chapter. There are entirely new sections on: Long QT syndrome; Brugada syndrome; and a completely rewritten section on cardiac failure. Several standards relating to a range of cardiac and related conditions have been clarified and/or supplemented to take account of changes in medical and related therapies. These include: implantable cardioverter defibrillators; aortic aneurysm and aortic dissection; high blood pressure (hypertension); cardiomyopathies; aortic stenosis; and congenital heart disease.
Clarification of standards for implantable cardioverter defibrillator. Clarification of standards for aortic aneurysm. Clarification of standards for hypertrophic cardiomyopathy with inclusion of the European Society of Cardiology Risk of Sudden Cardiac Death calculator (Appendix C).
‘Aortic aneurysm’ – layout changed to aid clarity. New section added called ‘Thoracic aortic aneurysm with bicuspid aortopathy’. ‘Congenital heart disease’ – revised and re-presented section.
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