Driving restrictions after ICD implantation may impede daily living
Click Here to Manage Email Alerts
Key takeaways:
- Private and professional driving restrictions after ICD implantation may negatively impact patient daily living and employment.
- Younger patients were more likely to report an impact.
Driving restrictions after implantable cardioverter defibrillator implantation negatively affected patient daily living, according to a study published in European Heart Journal – Quality of Care and Clinical Outcomes.
“For many individuals, motor vehicle driving represents individual freedom and can be essential to continuing normal daily living activities, including maintaining employment,” Malene Hammer Hansen, RN, MSc, a PhD student and clinical study coordinator in the department of cardiology at Copenhagen University Hospital — Herlev and Gentofte in Denmark, and colleagues wrote. “To date, there is an overall lack of quantitative patient-reported data on the impact of ICD implantation and driving restrictions on ICD recipients’ daily living and driving behavior.”
To examine the impact of private and professional driving restrictions after ICD implantation on daily living, employment status and driving behavior, Hansen and colleagues evaluated questionnaire responses from 2,741 patients in Denmark aged 18 years and older (median age, 67 years; 83% men) who received a first-time ICD from 2013 to 2016.
Researchers then linked responses from this survey to data from comprehensive nationwide Danish health registers, performing a multiple logistic regression analysis to identify variables associated with substantial impediment in daily living caused by the driving restrictions. The researchers also examined potential differences between women and men as well as younger and older ICD recipients.
Among the 465 patients with a driving ban lasting 1 month or longer who had been working before ICD implantation, 208 reported being very or somewhat limited in maintaining employment due to driving restrictions and 186 reported being very or somewhat limited in getting to and from their job.
Among 171 patients who were professional drivers, 56 reported losing their job due to the permanent driving ban, which was “surprisingly low considering that the majority were bus, truck or taxi drivers,” the researchers wrote.
“However, this agrees well with previously published results from this survey, showing that following ICD implantation, up to 35% of professional drivers resumed driving, despite the driving ban,” they wrote.
Of the 911 patients restricted from driving for at least 1 month after ICD implantation, 231 reported the restrictions had substantially impeded their daily living and 255 agreed or strongly agreed that the restrictions had made them feel like a burden to others.
The multivariable regression model showed that factors associated with substantial impediment on daily living included age younger than 65 years (OR = 1.84; 95% CI, 1.35-2.52), driving 7 or more hours per week before ICD implantation (OR = 1.66; 95% CI, 1.23-2.24), having a higher income (OR = 1.47; 95% CI, 1.05-2.05) and living in thinly populated areas (OR = 1.43; 95% CI, 1.06-1.92).
The researchers noted that more women than men reported being very or somewhat limited in running errands (67% vs. 53%) and meeting family and friends (61% vs. 44%).
Of the 2,344 patients who had resumed driving after ICD implantation, 58 reported being nervous about driving due to having an ICD implanted.
“Overall, our findings should be taken into consideration when constructing driving recommendations for ICD recipients,” the researchers wrote. “Policymakers on one hand must consider public safety when allowing patients with an ongoing risk of malignant arrhythmias and thus potentially sudden incapacitation to drive, but on the contrary the effects on patients’ quality of life can evidently be significant.”
The researchers acknowledged several limitations, including the use of patient-reported data, which introduced risk for information bias.
Collapse
Click Here to Manage Email Alerts