Driving restrictions following defibrillator implantation: a nationwide register-linked survey study on the impact on employment, daily living, and driving behaviour

Aims
Following implantation of an implantable cardioverter defibrillator (ICD), patients are temporarily restricted from private motor vehicle driving and permanently prohibited from professional driving. We aimed to investigate the impact of driving restrictions following ICD implantation and in the case of ICD shock on employment, daily living activities, driving concerns, and driving behaviour.

Methods and results
Data were retrieved from a nationwide survey on driving restrictions in Danish ICD patients, distributed in 2017 to all patients ≥18 years implanted with a first-time ICD from 2013 to 2016 (n = 3913). Responses were linked with data from nationwide registers. The response rate was 71% (final analysable population n = 2741, 83% male, median age 67 years, 316 had experienced an ICD shock, and 911 patients reported receipt of driving restrictions of minimum 1 month). Among active professional drivers (n = 175), 33% had lost their job as a direct consequence of the driving restrictions. Of those working prior to ICD implantation (n = 465), 47% reported being limited in maintaining employment due to private driving restrictions. Among those restricted from driving for a minimum of 1 month, 26% reported the restrictions overall had substantially impeded their daily living. Factors associated with substantial impediment were age <65 years [OR 1.84 (95% CI 1.35–2.52)], higher income [OR 1.47 (95% CI 1.05–2.05)], and driving ≥7 h/week pre-implantation [OR 1.66 (95% CI 1.23–2.24)]. Being nervous about driving or altering driving habits was reported by 3–7%.

Conclusion
Both professional and private driving restrictions affect the ability to maintain employment and have a negative impact on ICD recipients’ daily living activities.