Table of Contents

2.3.2 Conditional licences and periodic review

Because many cardiac conditions are stabilised and not cured, periodic review is recommended. In general the review interval should not exceed 12 months.

Where a condition has been effectively treated and there is minimal risk of recurrence, the driver may apply for reinstatement of an unconditional licence on the advice of the treating doctor or specialist (in the case of a commercial vehicle driver). Refer to Part A, section 4.5 Reinstatement of licences or removal or variation of licence conditions.

It is important that health professionals familiarise themselves with both the general information above and the tabulated standards before making an assessment of a person’s fitness to drive.

Medical standards for licensing – Cardiovascular conditions
Condition

Private standards

(Drivers of cars, light rigid vehicles or motorcycles unless carrying public passengers or requiring a dangerous goods driver licence – refer to definition)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition)

Ischaemic heart disease

Acute myocardial infarction (AMI)

Refer also to coronary artery bypass grafting (CABG).

Refer also to percutaneous coronary intervention (PCI).

The person should not drive for at least two weeks after an AMI.

A person is not fit to hold an unconditional licence:

  • if the person has had an AMI.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • it is at least two weeks after an uncomplicated AMI; and
  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

Fitness thereafter should be assessed in terms of general convalescence.

The person should not drive for at least four weeks after an AMI.

A person is not fit to hold an unconditional licence:

  • if the person has had an AMI.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • it is at least four weeks after an uncomplicated AMI; and
  • there is a satisfactory response to treatment; and
  • there is an exercise tolerance equal to or greater than 90% of the age/sex predicted exercise capacity according to the Bruce protocol or equivalent functional exercise test protocol; and
  • there is no evidence of severe ischaemia – that is, less than 2 mm ST segment depression on an exercise ECG or a reversible regional wall abnormality on an exercise stress echocardiogram or, absence of a large defect on a stress perfusion scan; and
  • there is an ejection fraction of 40% or over; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).
Angina

A person with angina, which is usually absent on mild exertion, and who is compliant with treatment may drive without licence restriction and without notification to the driver licensing authority, subject to periodic monitoring.

A person is not fit to hold an unconditional licence:

  • if the person is subject to angina pectoris at rest or on minimal exertion despite medical therapy, or has unstable angina.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

A person is not fit to hold an unconditional licence:

  • if the person is subject to angina pectoris.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • either or both:
    • there is an exercise tolerance equal to or greater than 90% of the age/sex predicted exercise capacity according to the Bruce protocol or equivalent functional exercise test protocol;
    • a resting or stress echocardiogram or a myocardial perfusion study, or both, show no evidence of ischaemia; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

Myocardial ischaemia

If myocardial ischaemia is demonstrated, a coronary angiogram may be offered.

A conditional licence may be considered, subject to annual review, if the following criterion is met:

  • the coronary angiogram (invasive or CT) shows lumen diameter reduction of less than 70% in a major coronary branch, and less than 50% in the left main coronary artery.

If the result of the angiogram shows a lumen diameter reduction of equal to or greater than 70% in a major coronary branch and less than 50% in the left main coronary artery (or if an angiogram is not conducted), a conditional licence may be considered, subject to annual review, if the following criteria are met:

  • there is an exercise tolerance equal to or greater than 90% of the age/sex predicted exercise capacity according to the Bruce protocol or equivalent functional exercise test protocol; and
  • there is no evidence of severe ischaemia – that is, less than 2 mm ST segment depression on an exercise ECG or a reversible regional wall abnormality on an exercise stress echocardiogram or, absence of a large defect on a stress perfusion scan; and
  • there is an ejection fraction of 40% or over; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

The above criteria also apply if an angiogram is not conducted.

Where surgery or PCI is undertaken to relieve the angina, the requirements listed in the table apply.

Coronary artery bypass grafting (CABG)

The person should not drive for at least four weeks after CABG.

A person is not fit to hold an unconditional licence:

  • if the person requires or has had CABG.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • it is at least four weeks after CABG; and
  • there is satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
  • there is minimal residual musculoskeletal pain after the chest surgery.

The person should not drive for at least three months after CABG.

A person is not fit to hold an unconditional licence:

  • if the person requires or has had CABG.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • it is at least three months after CABG; and
  • there is a satisfactory response to treatment; and
  • there is an exercise tolerance equal to or greater than 90% of the age/sex predicted exercise capacity according to the Bruce protocol or equivalent functional exercise test protocol; and
  • there is no evidence of severe ischaemia – that is, less than 2 mm ST segment depression on an exercise ECG or, a reversible regional wall abnormality on an exercise stress echocardiogram or, absence of a large defect on a stress perfusion scan; and
  • there is an ejection fraction of 40% or over; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
  • there is minimal residual musculoskeletal pain after the chest surgery.

Percutaneous coronary intervention (PCI)

(e.g. angioplasty)

The person should not drive for at least two days after the PCI.

A person is not fit to hold an unconditional licence:

  • if the person requires or has had a PCI.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • there was no AMI immediately before or after the PCI; and
  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

The person should not drive for at least four weeks after the PCI.

A person is not fit to hold an unconditional licence:

  • if the person requires or has had a PCI.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • it is at least four weeks after the PCI; and
  • there is a satisfactory response to treatment; and
  • there is an exercise tolerance equal to or greater than 90% of the age/sex predicted exercise capacity according to the Bruce protocol or equivalent functional exercise test protocol; and
  • there is no evidence of severe ischaemia – that is, less than 2 mm ST segment depression on an exercise ECG or a reversible regional wall abnormality on an exercise stress echocardiogram or absence of a large defect on a stress perfusion scan; and
  • there is an ejection fraction of 40% or over; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).
Disorders of rate, rhythm and conduction
Atrial fibrillation

The non-driving period will depend on the method of treatment – see below.

A person is not fit to hold an unconditional licence:

  • if an episode of fibrillation results in syncope or incapacitating symptoms.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

The person should not drive for:

  • at least one week following percutaneous intervention;
  • at least one week following initiation of successful medical treatment;
  • an appropriate time following open chest surgery.

* Where the condition is considered to be cured, the requirement for periodic review may be waived.

The non-driving period will depend on the method of treatment – see below.

A person is not fit to hold an unconditional licence:

  • if the person has a history of recurrent or persistent arrhythmia that may result in syncope or incapacitating symptoms.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
  • appropriate follow-up has been arranged.

The person should not drive for:

  • at least four weeks following percutaneous intervention;
  • at least four weeks following initiation of successful medical treatment;
  • at least three months following open chest surgery.

If the person is taking anticoagulants refer to anticoagulant therapy.

* Where the condition is considered to be cured, the requirement for periodic review may be waived.

Paroxysmal arrhythmias

(e.g. supraventricular tachycardia (SVT) atrial flutter, idiopathic ventricular tachycardia)

A person is not fit to hold an unconditional licence:

  • if there was near or definite collapse.

A conditional licence may be considered by the driver licensing authority subject to periodic review,* taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • there is a satisfactory response to treatment; and
  • there are normal haemodynamic responses at a moderate level of exercise; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

* Where the condition is considered to be cured, the requirement for periodic review may be waived.

The non-driving period is at least four weeks.

  • A person is not fit to hold an unconditional licence:

if there was near or definite collapse.

A conditional licence may be considered by the driver licensing authority subject to periodic review,* taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • there is a satisfactory response to treatment; and
  • there are normal haemodynamic responses at a moderate level of exercise; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

The person should not drive:

  • for at least four weeks following percutaneous intervention:
  • for at least four weeks following initiation of successful medical treatment.

* Where the condition is considered to be cured, the requirement for periodic review may be waived.

Cardiac arrest

The person should not drive for at least six months following a cardiac arrest.

Limited exceptions apply – see below.*

A person is not fit to hold an unconditional licence:

  • if the person has suffered a cardiac arrest.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • it is at least six months after the arrest; and
  • the cause of the cardiac arrest and response to treatment has been considered; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

* A shorter non-driving period than six months may be considered subject to specialist assessment if the cardiac arrest has occurred within 48 hours of an acute myocardial infarction, or if the arrhythmia causing the cardiac arrest has been addressed by a radio frequency ablation surgery or by pacemaker implantation.

The person should not drive for at least six months following a cardiac arrest.

A person is not fit to hold an unconditional licence:

  • if the person has suffered a cardiac arrest.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • it is at least six months after the arrest; and
  • a reversible cause is identified and recurrence is unlikely; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

Cardiac pacemaker

Refer also to Implantable cardioverter defibrillator (ICD) below if appropriate

The person should not drive for at least two weeks after insertion of a pacemaker.

A person is not fit to hold an unconditional licence:

  • if a cardiac pacemaker is required or has been implanted or replaced.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • it is at least two weeks after insertion of the cardiac pacemaker; and
  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

The person should not drive for at least four weeks after insertion of a pacemaker.

A person is not fit to hold an unconditional licence:

  • if a cardiac pacemaker is required or has been implanted or replaced.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • it is at least four weeks after insertion of the cardiac pacemaker; and
  • the relative risks of pacemaker dysfunction have been considered; and
  • there are normal haemodynamic responses at a moderate level of exercise; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).
Implantable cardioverter defibrillator (ICD)

The non-driving period will depend on the reason for ICD implantation – see below.

A person is not fit to hold an unconditional licence:

  • if the person requires or has had an ICD implanted for ventricular arrhythmias.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • the ICD has been implanted for an episode of cardiac arrest and the person has been asymptomatic for six months; or
  • the ICD has been prophylactically implanted for at least two weeks; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

A person should not drive:

  • for two weeks after a generator change of an ICD;
  • for at least four weeks after appropriate ICD therapy associated with symptoms of haemodynamic compromise (if syncopal, refer to syncope.

A person is not fit to hold an unconditional licence or a conditional licence:

  • if the person requires or has had an ICD implanted for ventricular arrhythmias, including those implanted for prophylaxis.

ECG changes:

Strain patterns, bundle branch blocks, heart block, etc.

Refer also to Cardiac pacemaker.

The person should not drive for at least two weeks following initiation of treatment.

A person is not fit to hold an unconditional licence:

  • if the conduction defect is causing symptoms.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • the condition has been treated procedurally or medically for at least two weeks; and
  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

* Where the condition is considered to be cured, the requirement for periodic review may be waived.

The person should not drive for at least three months following initiation of treatment.

A person is not fit to hold an unconditional licence:

  • if the person has an electrocardiographic abnormality, for example, left bundle branch block, right bundle branch block, pre-excitation, prolonged QT interval or changes suggestive of myocardial ischaemia or previous myocardial infarction.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • all of the following:
    • the condition has been treated procedurally or medically for at least three months; and
    • there is a satisfactory response to treatment; and
    • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); or
  • follow-up investigation has excluded underlying cardiac disease.

* Where the condition is considered to be cured, the requirement for periodic review may he waived.

Vascular disease
Aneurysms – abdominal and thoracic

The person should not drive for at least four weeks post repair.

A person is not fit to hold an unconditional licence:

  • if the person has an unrepaired aortic aneurysm, thoracic or abdominal.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • both:
    • it is at least four weeks after repair; and
    • the response to treatment is satisfactory, according to the treating vascular surgeon; or
  • in the case of atherosclerotic aneurysm or aneurysm associated with the bicuspid aortic valve, the aneurysm diameter is less than 55mm; or
  • the aneurysm diameter is less than 50mm.

The person should not drive for at least three months post repair.

A person is not fit to hold an unconditional licence:

  • if the person has an unrepaired aortic aneurysm, thoracic or abdominal.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • both:
    • it is at least three months after repair; and
    • the response to treatment is satisfactory, according to the treating vascular surgeon; or
  • in the case of atherosclerotic aneurysm or aneurysm associated with the bicuspid aortic valve, the aneurysm diameter is less than 55mm; or
  • the aneurysm diameter is less than 50mm.
Deep vein thrombosis (DVT)

There are no licensing criteria for DVT.

For advisory non-driving period following DVT refer to Table 5.

For long-term anticoagulation refer to Anticoagulant therapy. Refer also to section 2.2.8 in text.

There are no licensing criteria for DVT.

For advisory non-driving period following DVT refer to Table 5.

For long-term anticoagulation refer to Anticoagulant therapy. Refer also to section 2.2.8 in text.

Pulmonary embolism (PE)

There are no licensing criteria for PE.

For advisory non-driving period following PE refer to Table 5.

For long-term anticoagulation refer to Anticoagulant therapy. Refer also to section 2.2.8 in text.

There are no licensing criteria for PE.

For advisory non-driving period following PE refer to Table 5.

For long-term anticoagulation refer to Anticoagulant therapy. Refer also to section 2.2.8 in text.

Valvular heart disease (including treatment with Mitra Clips and Transcutaneous Aortic Valve Replacement)

The person should not drive for at least four weeks following valve repair.

A person is not fit to hold an unconditional licence:

  • if the person has symptoms on moderate exertion.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
  • there is minimal residual musculoskeletal pain after chest surgery, if required.

The person should not drive for at least four weeks following valve repair.

A person is not fit to hold an unconditional licence:

  • if the person has any history or evidence of valve disease, with or without surgical repair or replacement, associated with symptoms or a history of embolism, arrhythmia, cardiac enlargement, abnormal ECG or high blood pressure; or
  • if the person is taking anticoagulants (a conditional licence may be issued subject to the requirements specified in relation to anticoagulant therapy).

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • the person’s cardiological assessment shows valvular disease of no haemodynamic significance; or
  • all of the following:
    • it is three months following surgery and there is no evidence of valvular dysfunction; and
    • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
    • there is minimal residual musculoskeletal pain after chest surgery.
Myocardial diseases
Dilated cardiomyopathy

A person is not fit to hold an unconditional licence:

  • if the person has a dilated cardiomyopathy.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
  • the person is not subject to arrhythmias.

Cardiologist assessment is recommended for complex presentations.

A person is not fit to hold an unconditional licence:

  • if the person has a dilated cardiomyopathy.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • there is an ejection fraction of 40% or over; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
  • the person is not subject to arrhythmias.
Hypertrophic cardiomyopathy (HCM)

A person is not fit to hold an unconditional licence:

  • if the person has HCM.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
  • the person is not subject to arrhythmias or syncope.

A person is not fit to hold an unconditional licence:

  • if the person has HCM.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • the left ventricular ejection fraction is 40% or over; and
  • there is an exercise toleranc equal to or greater than 90% of the age/sex predicted exercise capacity according to the Bruce protocol or equivalent functional exercise test protocol; and
  • there is an absence of: a history of syncope; severe LV hypertrophy; a family history of sudden death; or ventricular arrhythmia on Holter testing; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).
Other cardiovascular diseases
Anticoagulant therapy

A person on a private vehicle licence may drive without restriction and without reporting to the driver licensing authority, pending periodic review if:

  • anticoagulation is maintained at the appropriate degree for the underlying condition.

A person is not fit to hold an unconditional licence:

  • if the person is on long-term anticoagulant therapy.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criterion is met:

  • anticoagulation is maintained at the appropriate degree for the underlying condition.
Congenital disorders

A person is not fit to hold an unconditional licence:

  • if the person has a complicated congenital heart disorder.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criterion is met:

  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

A person is not fit to hold an unconditional licence:

  • if the person has a complicated congenital heart disorder.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • there is a minor congenital heart disorder of no haemodynamic significance such as pulmonary stenosis, atrial septal defect, small ventricular septal defect, bicuspid aortic valve, patent ductus arteriosus or mild coarctation of the aorta; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

Heart failure

(refer also to ventricular assist devices (VAD) below)

A person is not fit to hold an unconditional licence:

  • if symptoms arise on moderate exertion.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

A person is not fit to hold an unconditional licence:

  • if the person has heart failure.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • there is a satisfactory response to treatment; and
  • there is an exercise tolerance equal to or greater than 90% of the age/sex predicted exercise capacity according to the Bruce protocol or equivalent functional exercise test protocol; and
  • there is an ejection fraction of 40% or over; and
  • the underlying cause of the heart failure is considered; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).
Ventricular assist devices (VAD)

A person should not drive for at least 3 months following insertion of a ventricular assist device.

A person is not fit to hold an unconditional licence

  • if the person requires a VAD.

In the case of a left ventricular assist device (LVAD), a conditional licence may be considered by the driver licensing authority subject to six-monthly review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • the device has been in situ for at least three months and there have been no equipment problems during the preceding two weeks; and
  • anticoagulation is stable as per this standard; and
  • the medical condition is stable and satisfactorily controlled, and there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness); and
  • the person is confident in relation to all LVAD equipment.

Where there is concern of cognitive or neurological impairment, a practical driver assessment should be conducted (refer to Part A section 2.3.1 Practical driver assessments).

A person is not fit to hold an unconditional licence or a conditional licence:

  • if the person requires a combined LVAD/RVAD or an artificial heart.

A person is not fit to hold an unconditional licence or a conditional licence:

  • if the person requires a VAD of any type or an artificial heart.
Heart transplant

The person should not drive for at least six weeks post-transplant.

A person is not fit to hold an unconditional licence:

  • if the person requires or has had a heart or heart/lung transplant.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

it is at least six weeks after transplant; and

  • there is a satisfactory response to treatment; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).

The person should not drive for at least three months post-transplant.

A person is not fit to hold an unconditional licence:

  • if the person requires or has had a heart or heart/lung transplant.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • it is at least three months after transplant; and
  • there is a satisfactory response to treatment; and
  • there is an exercise tolerance equal to or greater than 90% of the age/sex predicted exercise capacity according to the Bruce protocol or equivalent functional exercise test protocol; and
  • there are minimal symptoms relevant to driving (chest pain, palpitations, breathlessness).
Hypertension

A person is not fit to hold an unconditional licence:

  • if the person has blood pressure consistently greater than 200 systolic or greater than 110 diastolic (treated or untreated).

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • the blood pressure is well controlled; and
  • there are no side effects from the medication that will impair safe driving; and
  • there is no evidence of damage to target organs relevant to driving.

A person is not fit to hold an unconditional licence:

  • if the person has blood pressure consistently greater than 170 systolic or greater than 100 diastolic (treated or untreated).

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist* as to whether the following criteria are met:

  • the person is treated with antihypertensive therapy and effective control of hypertension is achieved over a four-week follow-up period; and
  • there are no side effects from the medication that will impair safe driving; and
  • there is no evidence of damage to target organs relevant to driving.

* Ongoing fitness to drive for commercial vehicle drivers may be assessed by the treating general practitioner provided this is mutually agreed by the specialist, general practitioner and driver licensing authority. The initial granting of a conditional licence must, however, be based on information provided by the specialist.

StrokeRefer to section 6 Neurological conditions.Refer to section 6 Neurological conditions.

Syncope

Refer also to section 1 Blackouts.

The person could resume driving within 24 hours if the episode was vasovagal in nature with a clear-cut precipitating factor (such as venesection) and the situation is unlikely to occur while driving. The driver licensing authority should not be notified.

The person should not drive for at least four weeks after syncope due to other cardiovascular causes.

A person is not fit to hold an unconditional licence:

  • if the condition is severe enough to cause episodes of loss of consciousness without warning.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • the underlying cause has been identified; and
  • satisfactory treatment has been instituted; and
  • the person has been symptom-free for at least four weeks.

The person could resume driving within 24 hours if the episode was vasovagal in nature with a clear-cut precipitating factor (such as venesection) and the situation is unlikely to occur while driving. The driver licensing authority should not be notified.

The person should not drive for at least three months after syncope due to other cardiovascular causes.

A person is not fit to hold an unconditional licence:

  • if the condition is severe enough to cause episodes of loss of consciousness without warning.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:

  • the underlying cause has been identified; and
  • satisfactory treatment has been instituted; and
  • the person has been symptom-free for three months.

IMPORTANT: The medical standards and management guidelines contained in this chapter should be read in conjunction with the general information contained in Part A of this publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing, suspending or cancelling, or reinstating a person’s driver licence (including a conditional licence) lies ultimately with the driver licensing authority.

Licensing decisions are based on a full consideration of relevant factors relating to health and driving performance.

Conditional licences

For a conditional licence to be issued, the health professional must provide to the driver licensing authority details of the medical criteria not met, evidence of the medical criteria met, as well as the proposed conditions and monitoring requirements.

The nature of the driving task

The driver licensing authority will take into consideration the nature of the driving task as well as the medical condition, particularly when granting a conditional licence. For example, the licence status of a farmer requiring a commercial vehicle licence for the occasional use of a heavy vehicle may be quite different from that of an interstate multiple combination vehicle driver. The examining health professional should bear this in mind when examining a person and when providing advice to the driver licensing authority.

The presence of other medical conditions

While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive, for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7 Multiple medical conditions and age-related change).

Reporting responsibilities

Patients should be made aware of the effects of their condition on driving and should be advised of their legal obligation to notify the driver licensing authority where driving is likely to be affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3.1 and step 6 of the assessment and reporting process).

References and further reading

  1. Monash University Accident Research Centre. Influence of chronic illness on crash involvement of motor vehicle drivers, 2nd edition, November 2010. Available: http://monashuniversity.mobi/muarc/reports/muarc300.html.
  2. Canadian Cardiovascular Society. Position statement on the management of thoracic aortic disease. Canadian Journal of Cardiology. 2014; 30: 577–589.
  3. Canadian Council of Motor Transport Administrators. Medical standards for drivers. September 2013. Available: http://ccmta.ca/en/publications/resources-home/item/determing-driver-fitness-in-canada-september-2013.
  4. Epstein A, Baessler CA, Curtis AB, Estes MNA, Gersh BJ, Grubb B, Mitchell BL. Addendum to ‘Personal and public safety issues related to arrhythmias that may affect consciousness: implications for regulation and physician recommendations: a medical/ scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology’. Circulation. 2007; 115: 1170–1176.
  5. Vijgen J, Botto G, Camm J, Hoijer CJ, Jung W, Le Heuzey JY, Lubinski A, Norekval TM, Santomauro M, Schalij M, Schmid JP, Vardas P. Consensus statement of the European Heart Rhythm Association: updated recommendations for driving by patients with implantable cardioverter defibrillators. Europace. 2009; 11: 1097–1107.
  6. Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH. Advanced heart failure treated with continuous-flow left ventricular assist device. New England Journal of Medicine. 2009; 361: 2241–2251.